bill setting a 90-day mediation deadline for out-of-network claims

The text as introduced · 250 words

2025S0220-T 03/12/25

By: Morgan
H.B. No. 4603

A BILL TO BE ENTITLED

AN ACT

relating to eligibility for mediation of certain out-of-network

health benefit claims.

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

SECTION 1. Section 1467.054(a), Insurance Code, is amended

to read as follows:

(a) Not later than the 90th day after the date an

out-of-network provider receives an initial payment for a health

care or medical service or supply, an [ An ] out-of-network provider

or a health benefit plan issuer or administrator may request

mandatory mediation under this subchapter.

SECTION 2. (a) Not later than the 30th day after the

effective date of this Act, the commissioner of insurance shall

adopt rules necessary to implement the changes in law made by this

Act.

(b) The changes in law made by this Act apply only to a

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

30th day after the effective date of this Act. A health care or

medical service or supply provided before that date is governed by

the law in effect immediately before the effective date of this Act,

and that law is continued in effect for that purpose.

SECTION 3. This Act takes effect immediately if it receives

a vote of two-thirds of all the members elected to each house, as

provided by Section 39, Article III, Texas Constitution. If this

Act does not receive the vote necessary for immediate effect, this

Act takes effect September 1, 2025.