Sec. 1377.052. UTILIZATION REVIEW. (a) A utilization review agent acting on behalf of a health benefit plan issuer may review a treating physician's determination of the medical necessity of the use of an amino acid-based elemental formula for the treatment of an enrollee who is diagnosed with a disease or disorder listed in Section 1377.051(a).
(b) Utilization review under this section is subject to Chapter 4201.
Added by Acts 2009, 81st Leg., R.S., Ch. 1129 (H.B. 2000), Sec. 1, eff. September 1, 2009.
Structure Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Subtitle E - Benefits Payable Under Health Coverages
Chapter 1377 - Coverage for Certain Amino Acid-Based Elemental Formulas
Subchapter B. Coverage for Certain Amino Acid-Based Elemental Formulas
Section 1377.051. Required Coverage for Certain Amino Acid-Based Elemental Formulas