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A BILL TO BE ENTITLED
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AN ACT
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Relating to arbitration of certain out-of-network health benefit |
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claims. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1467.001(6-a), Insurance Code, is |
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amended to read as follows: |
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(6-a) "Out-of-network provider" means a diagnostic |
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imaging provider, emergency care provider, facility-based |
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provider, or laboratory service provider that is not a |
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participating provider for a health benefit plan. The term includes |
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a group of out-of-network providers identified by one of the |
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following: |
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(A) a National Provider Identification Number; |
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(B) a group National Provider Identification |
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Number; |
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(C) an Employer Identification Number. |
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SECTION 2. Section 1467.087(e), Insurance Code, is amended |
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to read as follows: |
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(e) The losing party [parties] shall [evenly split and] pay |
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the arbitrator's fees and expenses not later than the 30th day after |
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the date the arbitrator provides the parties with the written |
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decision. |
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SECTION 3. The changes in law made by this Act apply only to a |
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health care or medical service or supply provided on or after |
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January 1, 2026. A health care or medical services 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 4. This Act takes effect September 1, 2025. |