| 1 | 1 | | 88R11818 CJD-F |
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| 2 | 2 | | By: Hughes S.B. No. 1298 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | A BILL TO BE ENTITLED |
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| 6 | 6 | | AN ACT |
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| 7 | 7 | | relating to requests for arbitration of certain billing disputes |
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| 8 | 8 | | between health benefit plan issuers or administrators and |
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| 9 | 9 | | out-of-network facilities. |
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| 10 | 10 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 11 | 11 | | SECTION 1. Section 1467.081, Insurance Code, is amended to |
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| 12 | 12 | | read as follows: |
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| 13 | 13 | | Sec. 1467.081. APPLICABILITY OF SUBCHAPTER. Except as |
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| 14 | 14 | | provided by Section 1467.103, this [This] subchapter applies only |
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| 15 | 15 | | with respect to a health benefit claim submitted by an |
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| 16 | 16 | | out-of-network provider who is not a facility. |
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| 17 | 17 | | SECTION 2. Section 1467.101, Insurance Code, is amended by |
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| 18 | 18 | | adding Subsection (c) to read as follows: |
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| 19 | 19 | | (c) The following conduct constitutes bad faith |
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| 20 | 20 | | participation with respect to mediation under Subchapter B: |
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| 21 | 21 | | (1) failing to provide the material facts necessary to |
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| 22 | 22 | | conduct a meaningful mediation process; or |
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| 23 | 23 | | (2) failing to send to mediation a representative who |
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| 24 | 24 | | is authorized to negotiate on the party's behalf. |
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| 25 | 25 | | SECTION 3. Subchapter C, Chapter 1467, Insurance Code, is |
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| 26 | 26 | | amended by adding Section 1467.103 to read as follows: |
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| 27 | 27 | | Sec. 1467.103. REQUEST FOR ARBITRATION. (a) Bad faith |
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| 28 | 28 | | participation with respect to mediation under Subchapter B by a |
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| 29 | 29 | | party to the mediation is grounds for the opposing party to request |
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| 30 | 30 | | arbitration under Subchapter B-1. |
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| 31 | 31 | | (b) On a request for arbitration under Subsection (a): |
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| 32 | 32 | | (1) the out-of-network facility that is a party to the |
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| 33 | 33 | | mediation is considered an out-of-network provider for purposes of |
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| 34 | 34 | | the arbitration under Subchapter B-1; and |
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| 35 | 35 | | (2) the department shall: |
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| 36 | 36 | | (A) select an arbitrator; and |
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| 37 | 37 | | (B) require the arbitrator to make a |
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| 38 | 38 | | determination not later than the 30th day after the date the |
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| 39 | 39 | | arbitrator receives the information necessary to make the |
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| 40 | 40 | | determination under Section 1467.083. |
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| 41 | 41 | | (c) Not later than the 30th day after the date an |
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| 42 | 42 | | arbitrator's written decision is provided to the parties under |
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| 43 | 43 | | Section 1467.088, the health benefit plan issuer or administrator |
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| 44 | 44 | | shall pay the out-of-network facility any additional amount |
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| 45 | 45 | | necessary to satisfy the award. |
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| 46 | 46 | | SECTION 4. Section 1467.103, Insurance Code, as added by |
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| 47 | 47 | | this Act, applies only to a claim for health care or medical |
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| 48 | 48 | | services or supplies provided on or after January 1, 2024. |
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| 49 | 49 | | SECTION 5. This Act takes effect September 1, 2023. |
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