88R11818 CJD-F
By: Hughes S.B. No. 1298
A BILL TO BE ENTITLED
AN ACT
relating to requests for arbitration of certain billing disputes
between health benefit plan issuers or administrators and
out-of-network facilities.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1467.081, Insurance Code, is amended to
read as follows:
Sec. 1467.081. APPLICABILITY OF SUBCHAPTER. Except as
provided by Section 1467.103, this [This] subchapter applies only
with respect to a health benefit claim submitted by an
out-of-network provider who is not a facility.
SECTION 2. Section 1467.101, Insurance Code, is amended by
adding Subsection (c) to read as follows:
(c) The following conduct constitutes bad faith
participation with respect to mediation under Subchapter B:
(1) failing to provide the material facts necessary to
conduct a meaningful mediation process; or
(2) failing to send to mediation a representative who
is authorized to negotiate on the party's behalf.
SECTION 3. Subchapter C, Chapter 1467, Insurance Code, is
amended by adding Section 1467.103 to read as follows:
Sec. 1467.103. REQUEST FOR ARBITRATION. (a) Bad faith
participation with respect to mediation under Subchapter B by a
party to the mediation is grounds for the opposing party to request
arbitration under Subchapter B-1.
(b) On a request for arbitration under Subsection (a):
(1) the out-of-network facility that is a party to the
mediation is considered an out-of-network provider for purposes of
the arbitration under Subchapter B-1; and
(2) the department shall:
(A) select an arbitrator; and
(B) require the arbitrator to make a
determination not later than the 30th day after the date the
arbitrator receives the information necessary to make the
determination under Section 1467.083.
(c) Not later than the 30th day after the date an
arbitrator's written decision is provided to the parties under
Section 1467.088, the health benefit plan issuer or administrator
shall pay the out-of-network facility any additional amount
necessary to satisfy the award.
SECTION 4. Section 1467.103, Insurance Code, as added by
this Act, applies only to a claim for health care or medical
services or supplies provided on or after January 1, 2024.
SECTION 5. This Act takes effect September 1, 2023.