The Texas Department of Insurance (TDI) encourages health insurers, health maintenance organizations (HMOs), and utilization review agents to extend prior authorizations for elective procedures authorized before Governor Greg Abbott’s executive order on March 22, 2020, directing a postponement of those procedures.
Executive Order No. GA-09 directed all licensed health-care professionals and facilities to postpone all surgeries and procedures not immediately medically necessary to correct a serious medical condition of, or to preserve the life of, the patient. On April 17, 2020, Governor Abbott issued Executive Order No. GA-15 that allowed elective surgeries and procedures under certain circumstances.
To help patients and health-care providers reschedule elective procedures without additional delays, TDI encourages health insurers, HMOs, and utilization review agents to:
- Automatically extend prior authorizations granted before March 22, 2020.
- Consider extending referrals for specialists, therapy, counseling services, and other medically necessary services that may have been disrupted.
- Provide consumers and providers with written notice of updated authorizations. These notices can be provided electronically through portals if available.
Providers remain responsible for completing other documentation that may be required for reimbursement.
This bulletin does not apply to one-time service authorizations already completed, new requests for authorization, or pharmacy prior authorizations.
For questions about this bulletin, contact the Life and Health Division at MCQA@tdi.texas.gov.