SECTION 3.8005. Utilization Review

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(a) Treatment providers and payors shall provide for utilization review in accordance with the provisions of this subchapter and of Chapter 19, Subchapter R of this title (relating to Utilization Review Agents). Both payor and treatment provider shall make available a qualified credentialed counselor to discuss the appropriateness of treatment, including levels of care, should this become necessary.
(b) Since utilization review as proposed in these standards must be accomplished in a timely manner, information provided telephonically must be supported by documentation in the patient record and available on request for review.
(c) A payor shall not require an individual to have failed an episode of outpatient therapy as a qualification for admission to inpatient therapy if the individual otherwise meets the criteria for admission to inpatient therapy.

Source Note: The provisions of this §3.8005 adopted to be effective August 28, 1991, 16 TexReg 4403; amended to be effective February 14, 1999, 24 TexReg 713

                    
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