bill tightening out-of-network billing mediation

The text as introduced · 436 words

89R14083 SCL-F

By: Oliverson
H.B. No. 3366

A BILL TO BE ENTITLED

AN ACT

relating to mediation and arbitration between health benefit plan

issuers or administrators and out-of-network health care

providers.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Section 1467.051(b), Insurance Code, is amended

to read as follows:

(b) If a person requests mediation under this subchapter,

the out-of-network provider or the provider's representative, and a

representative of the health benefit plan issuer or the

administrator, as appropriate, shall participate in the mediation.

Each party's representative must have the authority to reach an

agreement in the mediation. The representative of a health benefit

plan issuer or administrator must have the authority to bind the

issuer or administrator to pay the amount in the agreement.

SECTION 2. Section 1467.054, Insurance Code, is amended by

adding Subsection (c) to read as follows:

(c) As soon as practicable after the mediator is appointed,

a health benefit plan issuer or administrator that is a party to the

mediation shall provide the mediator the issuer's or

administrator's complete contact information necessary to begin

the mediation, including contact information for the issuer's or

administrator's representative or scheduler.

SECTION 3. Subchapter B, Chapter 1467, Insurance Code, is

amended by adding Section 1467.057 to read as follows:

Sec. 1467.057. MEDIATOR'S RIGHT TO COMPEL ARBITRATION. (a)

Not later than the 45th day after the date that the mediator's

report is provided to the department under Section 1467.060, the

mediator of a mediation for which there was no agreement may compel

arbitration under Subchapter B-1 to determine the amount due to the

out-of-network provider if the mediator determines that a party

failed to participate in the mediation in good faith.

(b) A party may not bring a civil action under Section

1467.0575 if the mediator orders arbitration under this section.

SECTION 4. Section 1467.087(e), Insurance Code, is amended

to read as follows:

(e) The parties shall evenly split and pay the arbitrator's

fees and expenses. The fees may not exceed the maximum amount fixed

by commissioner rule. In fixing the maximum amount, the

commissioner shall determine a reasonable amount that fairly

compensates the arbitrator.

SECTION 5. The changes in law made by this Act apply only to

a health care or medical service or supply provided on or after

January 1, 2026. A health care or medical service or supply

provided before January 1, 2026, is governed by the law as it

existed immediately before the effective date of this Act, and that

law is continued in effect for that purpose.

SECTION 6. This Act takes effect September 1, 2025.