| 1 | 1 | | 89R14083 SCL-F |
|---|
| 2 | 2 | | By: Oliverson H.B. No. 3366 |
|---|
| 3 | 3 | | |
|---|
| 4 | 4 | | |
|---|
| 5 | 5 | | |
|---|
| 6 | 6 | | |
|---|
| 7 | 7 | | A BILL TO BE ENTITLED |
|---|
| 8 | 8 | | AN ACT |
|---|
| 9 | 9 | | relating to mediation and arbitration between health benefit plan |
|---|
| 10 | 10 | | issuers or administrators and out-of-network health care |
|---|
| 11 | 11 | | providers. |
|---|
| 12 | 12 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|---|
| 13 | 13 | | SECTION 1. Section 1467.051(b), Insurance Code, is amended |
|---|
| 14 | 14 | | to read as follows: |
|---|
| 15 | 15 | | (b) If a person requests mediation under this subchapter, |
|---|
| 16 | 16 | | the out-of-network provider or the provider's representative, and a |
|---|
| 17 | 17 | | representative of the health benefit plan issuer or the |
|---|
| 18 | 18 | | administrator, as appropriate, shall participate in the mediation. |
|---|
| 19 | 19 | | Each party's representative must have the authority to reach an |
|---|
| 20 | 20 | | agreement in the mediation. The representative of a health benefit |
|---|
| 21 | 21 | | plan issuer or administrator must have the authority to bind the |
|---|
| 22 | 22 | | issuer or administrator to pay the amount in the agreement. |
|---|
| 23 | 23 | | SECTION 2. Section 1467.054, Insurance Code, is amended by |
|---|
| 24 | 24 | | adding Subsection (c) to read as follows: |
|---|
| 25 | 25 | | (c) As soon as practicable after the mediator is appointed, |
|---|
| 26 | 26 | | a health benefit plan issuer or administrator that is a party to the |
|---|
| 27 | 27 | | mediation shall provide the mediator the issuer's or |
|---|
| 28 | 28 | | administrator's complete contact information necessary to begin |
|---|
| 29 | 29 | | the mediation, including contact information for the issuer's or |
|---|
| 30 | 30 | | administrator's representative or scheduler. |
|---|
| 31 | 31 | | SECTION 3. Subchapter B, Chapter 1467, Insurance Code, is |
|---|
| 32 | 32 | | amended by adding Section 1467.057 to read as follows: |
|---|
| 33 | 33 | | Sec. 1467.057. MEDIATOR'S RIGHT TO COMPEL ARBITRATION. (a) |
|---|
| 34 | 34 | | Not later than the 45th day after the date that the mediator's |
|---|
| 35 | 35 | | report is provided to the department under Section 1467.060, the |
|---|
| 36 | 36 | | mediator of a mediation for which there was no agreement may compel |
|---|
| 37 | 37 | | arbitration under Subchapter B-1 to determine the amount due to the |
|---|
| 38 | 38 | | out-of-network provider if the mediator determines that a party |
|---|
| 39 | 39 | | failed to participate in the mediation in good faith. |
|---|
| 40 | 40 | | (b) A party may not bring a civil action under Section |
|---|
| 41 | 41 | | 1467.0575 if the mediator orders arbitration under this section. |
|---|
| 42 | 42 | | SECTION 4. Section 1467.087(e), Insurance Code, is amended |
|---|
| 43 | 43 | | to read as follows: |
|---|
| 44 | 44 | | (e) The parties shall evenly split and pay the arbitrator's |
|---|
| 45 | 45 | | fees and expenses. The fees may not exceed the maximum amount fixed |
|---|
| 46 | 46 | | by commissioner rule. In fixing the maximum amount, the |
|---|
| 47 | 47 | | commissioner shall determine a reasonable amount that fairly |
|---|
| 48 | 48 | | compensates the arbitrator. |
|---|
| 49 | 49 | | SECTION 5. The changes in law made by this Act apply only to |
|---|
| 50 | 50 | | a health care or medical service or supply provided on or after |
|---|
| 51 | 51 | | January 1, 2026. A health care or medical service or supply |
|---|
| 52 | 52 | | provided before January 1, 2026, is governed by the law as it |
|---|
| 53 | 53 | | existed immediately before the effective date of this Act, and that |
|---|
| 54 | 54 | | law is continued in effect for that purpose. |
|---|
| 55 | 55 | | SECTION 6. This Act takes effect September 1, 2025. |
|---|