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A BILL TO BE ENTITLED
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AN ACT
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relating to mediation or arbitration of certain billing disputes |
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between health benefit plan issuers or administrators and |
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out-of-network facilities. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1467.081, Insurance Code, is amended to |
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read as follows: |
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Sec. 1467.081. APPLICABILITY OF SUBCHAPTER. Except as |
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provided by Section 1467.103, this [This] subchapter applies only |
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with respect to a health benefit claim submitted by an |
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out-of-network provider who is not a facility. |
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SECTION 2. Section 1467.101, Insurance Code, is amended by |
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adding Subsection (c) to read as follows: |
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(c) The following conduct constitutes bad faith |
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participation with respect to mediation under Subchapter B: |
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(1) failing to provide the material facts necessary to |
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conduct a meaningful mediation process; or |
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(2) failing to send to mediation a representative who |
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is authorized to negotiate on the party's behalf. |
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SECTION 3. Subchapter C, Chapter 1467, Insurance Code, is |
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amended by adding Section 1467.103 to read as follows: |
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Sec. 1467.103. REQUEST FOR ARBITRATION. (a) Bad faith |
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participation with respect to mediation under Subchapter B by a |
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party to the mediation is grounds for the opposing party to request |
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arbitration under Subchapter B-1. |
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(b) On a request for arbitration under Subsection (a): |
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(1) the out-of-network facility that is a party to the |
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mediation is considered an out-of-network provider for purposes of |
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the arbitration under Subchapter B-1; and |
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(2) the department shall: |
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(A) select an arbitrator; and |
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(B) require the arbitrator to make a |
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determination not later than the 30th day after the date the |
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arbitrator receives the information necessary to make the |
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determination under Section 1467.083. |
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(c) Not later than the 30th day after the date an |
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arbitrator's written decision is provided to the parties under |
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Section 1467.088, the health benefit plan issuer or administrator |
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shall pay the out-of-network facility any additional amount |
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necessary to satisfy the award. |
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SECTION 4. The changes in law made by this Act apply only to |
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a claim for health care or medical services or supplies provided on |
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or after January 1, 2026. |
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SECTION 5. This Act takes effect September 1, 2025. |