Prior Authorization for Certain Drugs
Source:
Section 1575.170 — Prior Authorization for Certain Drugs, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1575.htm#1575.170 (accessed Feb. 26, 2025).
1575.001
Short Title 1575.002
General Definitions 1575.003
Definition of Dependent and Related Terms 1575.004
Definition of Retiree 1575.005
Issuance of Certificate of Coverage 1575.006
Exemption from Process 1575.007
Exemption from State Taxes and Fees 1575.008
Coverage Exempt from Insurance Law 1575.009
Balance Billing Prohibition Notice 1575.010
Information Regarding Appeals 1575.0025
References to Basic Plan 1575.051
Administration of Group Program 1575.052
Authority to Adopt Rules and Procedures 1575.053
Personnel 1575.054
Budget 1575.055
Department Assistance 1575.056
Transfer of Records Relating to Active Employee Program 1575.101
System as Group Plan Holder 1575.102
Self-insured Plans 1575.104
Terms of Contract 1575.105
Plan Coverage Secondary to Certain Other Coverage 1575.106
Competitive Bidding Requirements 1575.107
Contract Award 1575.108
Use of Private Entities 1575.109
Use of Health Care Provider 1575.110
Pharmacy Benefit Manager Contracts 1575.151
Types of Coverages 1575.152
Health Benefit Plan Must Cover Preexisting Conditions 1575.153
Health Benefit Plan Coverage for Retirees 1575.155
Coverage for Dependents of Retiree 1575.156
Coverage for Surviving Spouse or Dependents of Surviving Spouse 1575.157
Coverage for Surviving Dependent Child 1575.158
Group Health Benefit Plans 1575.159
Coverage for Prostate-specific Antigen Test 1575.160
Group Life or Accidental Death and Dismemberment Insurance: Payment of Claim 1575.161
Enrollment Periods 1575.162
Special Enrollments 1575.163
Limitations 1575.164
Disease Management Services 1575.170
Prior Authorization for Certain Drugs 1575.171
Emergency Care Payments 1575.172
Out-of-network Facility-based Provider Payments 1575.173
Out-of-network Diagnostic Imaging Provider or Laboratory Service Provider Payments 1575.174
Out-of-network Emergency Medical Services Provider Payments 1575.201
Additional State Contributions 1575.202
State Contribution Based on Active Employee Compensation 1575.203
Active Employee Contribution 1575.204
Public School Contribution 1575.206
Contributions Held in Trust for Fund 1575.207
Interest Assessed on Late Payment of Deposits by Employing Public Schools 1575.208
Certification of Amount Necessary to Pay State Contributions 1575.209
Certification of Amount of State Contributions 1575.210
Payment of State Contributions 1575.211
Cost Sharing 1575.212
Payment by Retirees 1575.213
Certain Disability Retirees 1575.251
Definition 1575.252
Application by Employer for Money to Pay State Contributions 1575.253
Monthly Certification 1575.254
Monthly Maintenance of Information 1575.255
Proof of Compliance 1575.256
Criminal Offense: Failure of Administrator to Comply 1575.257
Civil Sanctions for Failure of Employer to Comply 1575.301
Fund 1575.302
Payments into Fund 1575.303
Payments from Fund 1575.304
Transfer of Certain Contributions 1575.305
Investment of Fund 1575.306
Employee Contributions Property of Fund on Receipt 1575.307
Contingency Reserve Account 1575.351
Definitions 1575.352
Implementation and Administration 1575.353
Contracts with Health Care Providers and Others 1575.354
Credentialing Committees 1575.355
Immunity from Liability Arising from Acts or Omissions of Health Care Provider 1575.356
Immunity from Liability Arising from Evaluation of Qualifications or Care 1575.357
Immunity from Liability Arising from Acts Relating to Credentialing Committee 1575.358
Open Meetings Law Not Applicable to Credentialing Committee 1575.359
Records and Proceedings of Credentialing Committee Not Subject to Subpoena 1575.360
Confidentiality 1575.361
Disclosure to Health Care Provider 1575.362
Disclosure to Certain Entities 1575.363
Disclosure to Defendants in Civil Actions 1575.401
Definition 1575.402
Appointment of Committee Members 1575.403
Terms 1575.404
Vacancy 1575.405
Meetings 1575.406
Duties 1575.407
Procedural Rules 1575.408
Reimbursement for Actual and Reasonable Expenses 1575.451
Annual Accounting 1575.453
Study and Report by Trustee 1575.454
Reports by and Examination of Carrier 1575.455
Public Inspection 1575.456
Confidentiality of Records 1575.501
Expulsion for Fraud 1575.502
Hearing 1575.503
Contested Case 1575.504
Expulsion at Conclusion of Hearing 1575.505
Effect of Expulsion 1575.506
Appeal 1575.1582
Eligibility for Group Health Benefit Plans 1575.1601
Group Benefits for Dental and Vision Care 1575.1701
Exemption from Preauthorization Requirements for Physicians and Health Care Providers Providing Certain Health Care Services
Short Title 1575.002
General Definitions 1575.003
Definition of Dependent and Related Terms 1575.004
Definition of Retiree 1575.005
Issuance of Certificate of Coverage 1575.006
Exemption from Process 1575.007
Exemption from State Taxes and Fees 1575.008
Coverage Exempt from Insurance Law 1575.009
Balance Billing Prohibition Notice 1575.010
Information Regarding Appeals 1575.0025
References to Basic Plan 1575.051
Administration of Group Program 1575.052
Authority to Adopt Rules and Procedures 1575.053
Personnel 1575.054
Budget 1575.055
Department Assistance 1575.056
Transfer of Records Relating to Active Employee Program 1575.101
System as Group Plan Holder 1575.102
Self-insured Plans 1575.104
Terms of Contract 1575.105
Plan Coverage Secondary to Certain Other Coverage 1575.106
Competitive Bidding Requirements 1575.107
Contract Award 1575.108
Use of Private Entities 1575.109
Use of Health Care Provider 1575.110
Pharmacy Benefit Manager Contracts 1575.151
Types of Coverages 1575.152
Health Benefit Plan Must Cover Preexisting Conditions 1575.153
Health Benefit Plan Coverage for Retirees 1575.155
Coverage for Dependents of Retiree 1575.156
Coverage for Surviving Spouse or Dependents of Surviving Spouse 1575.157
Coverage for Surviving Dependent Child 1575.158
Group Health Benefit Plans 1575.159
Coverage for Prostate-specific Antigen Test 1575.160
Group Life or Accidental Death and Dismemberment Insurance: Payment of Claim 1575.161
Enrollment Periods 1575.162
Special Enrollments 1575.163
Limitations 1575.164
Disease Management Services 1575.170
Prior Authorization for Certain Drugs 1575.171
Emergency Care Payments 1575.172
Out-of-network Facility-based Provider Payments 1575.173
Out-of-network Diagnostic Imaging Provider or Laboratory Service Provider Payments 1575.174
Out-of-network Emergency Medical Services Provider Payments 1575.201
Additional State Contributions 1575.202
State Contribution Based on Active Employee Compensation 1575.203
Active Employee Contribution 1575.204
Public School Contribution 1575.206
Contributions Held in Trust for Fund 1575.207
Interest Assessed on Late Payment of Deposits by Employing Public Schools 1575.208
Certification of Amount Necessary to Pay State Contributions 1575.209
Certification of Amount of State Contributions 1575.210
Payment of State Contributions 1575.211
Cost Sharing 1575.212
Payment by Retirees 1575.213
Certain Disability Retirees 1575.251
Definition 1575.252
Application by Employer for Money to Pay State Contributions 1575.253
Monthly Certification 1575.254
Monthly Maintenance of Information 1575.255
Proof of Compliance 1575.256
Criminal Offense: Failure of Administrator to Comply 1575.257
Civil Sanctions for Failure of Employer to Comply 1575.301
Fund 1575.302
Payments into Fund 1575.303
Payments from Fund 1575.304
Transfer of Certain Contributions 1575.305
Investment of Fund 1575.306
Employee Contributions Property of Fund on Receipt 1575.307
Contingency Reserve Account 1575.351
Definitions 1575.352
Implementation and Administration 1575.353
Contracts with Health Care Providers and Others 1575.354
Credentialing Committees 1575.355
Immunity from Liability Arising from Acts or Omissions of Health Care Provider 1575.356
Immunity from Liability Arising from Evaluation of Qualifications or Care 1575.357
Immunity from Liability Arising from Acts Relating to Credentialing Committee 1575.358
Open Meetings Law Not Applicable to Credentialing Committee 1575.359
Records and Proceedings of Credentialing Committee Not Subject to Subpoena 1575.360
Confidentiality 1575.361
Disclosure to Health Care Provider 1575.362
Disclosure to Certain Entities 1575.363
Disclosure to Defendants in Civil Actions 1575.401
Definition 1575.402
Appointment of Committee Members 1575.403
Terms 1575.404
Vacancy 1575.405
Meetings 1575.406
Duties 1575.407
Procedural Rules 1575.408
Reimbursement for Actual and Reasonable Expenses 1575.451
Annual Accounting 1575.453
Study and Report by Trustee 1575.454
Reports by and Examination of Carrier 1575.455
Public Inspection 1575.456
Confidentiality of Records 1575.501
Expulsion for Fraud 1575.502
Hearing 1575.503
Contested Case 1575.504
Expulsion at Conclusion of Hearing 1575.505
Effect of Expulsion 1575.506
Appeal 1575.1582
Eligibility for Group Health Benefit Plans 1575.1601
Group Benefits for Dental and Vision Care 1575.1701
Exemption from Preauthorization Requirements for Physicians and Health Care Providers Providing Certain Health Care Services
