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A BILL TO BE ENTITLED
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AN ACT
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relating to mediation and arbitration between health benefit plan |
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issuers or administrators and out-of-network health care |
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providers. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1467.051(b), Insurance Code, is amended |
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to read as follows: |
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(b) If a person requests mediation under this subchapter, |
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the out-of-network provider or the provider's representative, and a |
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representative of the health benefit plan issuer or the |
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administrator, as appropriate, shall participate in the mediation. |
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Each party's representative must have the authority to reach an |
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agreement in the mediation. The representative of a health benefit |
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plan issuer or administrator must have the authority to bind the |
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issuer or administrator to pay the amount in the agreement. |
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SECTION 2. Section 1467.054, Insurance Code, is amended by |
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adding Subsection (c) to read as follows: |
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(c) As soon as practicable after the mediator is appointed, |
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a health benefit plan issuer or administrator that is a party to the |
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mediation shall provide the mediator the issuer's or |
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administrator's complete contact information necessary to begin |
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the mediation, including contact information for the issuer's or |
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administrator's representative or scheduler. |
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SECTION 3. Subchapter B, Chapter 1467, Insurance Code, is |
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amended by adding Section 1467.057 to read as follows: |
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Sec. 1467.057. MEDIATOR'S RIGHT TO COMPEL ARBITRATION. (a) |
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Not later than the 45th day after the date that the mediator's |
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report is provided to the department under Section 1467.060, the |
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mediator of a mediation for which there was no agreement may compel |
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arbitration under Subchapter B-1 to determine the amount due to the |
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out-of-network provider if the mediator determines that a party |
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failed to participate in the mediation in good faith. |
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(b) A party may not bring a civil action under Section |
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1467.0575 if the mediator orders arbitration under this section. |
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SECTION 4. Section 1467.087(e), Insurance Code, is amended |
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to read as follows: |
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(e) The parties shall evenly split and pay the arbitrator's |
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fees and expenses. The fees may not exceed the maximum amount fixed |
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by commissioner rule. In fixing the maximum amount, the |
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commissioner shall determine a reasonable amount that fairly |
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compensates the arbitrator. |
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SECTION 5. The changes in law made by this Act apply only to |
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a health care or medical service or supply provided on or after |
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January 1, 2026. A health care or medical service or supply |
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provided before January 1, 2026, is governed by the law as it |
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existed immediately before the effective date of this Act, and that |
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law is continued in effect for that purpose. |
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SECTION 6. This Act takes effect September 1, 2025. |