Texas § 4201.153 SCREENING CRITERIA AND REVIEW PROCEDURES.

Texas Statutes

§ 4201.153 — SCREENING CRITERIA AND REVIEW PROCEDURES.

Texas § 4201.153

Code INInsurance Code

This text of Texas § 4201.153 (SCREENING CRITERIA AND REVIEW PROCEDURES.) is published on Counsel Stack Legal Research, covering Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Tex. Insurance Code Code Ann. § 4201.153 (2026).

Text

Sec. 4201.153. SCREENING CRITERIA AND REVIEW PROCEDURES.

(a)A utilization review agent shall use written medically acceptable screening criteria and review procedures that are established and periodically evaluated and updated with appropriate involvement from physicians, including practicing physicians, dentists, and other health care providers.

(b)A utilization review determination shall be made in accordance with currently accepted medical or health care practices, taking into account special circumstances of the case that may require deviation from the norm stated in the screening criteria.

(c)Screening criteria must be:

(1)objective;

(2)clinically valid;

(3)compatible with established principles of health care; and

(4)flexible enough to allow a deviation from the norm when just

Free access — add to your briefcase to read the full text and ask questions with AI

Sec. 4201.153. SCREENING CRITERIA AND REVIEW PROCEDURES. (a) A utilization review agent shall use written medically acceptable screening criteria and review procedures that are established and periodically evaluated and updated with appropriate involvement from physicians, including practicing physicians, dentists, and other health care providers.
(b) A utilization review determination shall be made in accordance with currently accepted medical or health care practices, taking into account special circumstances of the case that may require deviation from the norm stated in the screening criteria.
(c) Screening criteria must be:
(1) objective;
(2) clinically valid;
(3) compatible with established principles of health care; and
(4) flexible enough to allow a deviation from the norm when justified on a case-by-case basis.
(d) Screening criteria must be used to determine only whether to approve the requested treatment. A denial of requested treatment must be referred to an appropriate physician, dentist, or other health care provider to determine medical necessity.