By: Dyson H.B. No. 5036
A BILL TO BE ENTITLED
AN ACT
Relating to arbitration of certain out-of-network health benefit
claims.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1467.001(6-a), Insurance Code, is
amended to read as follows:
(6-a) "Out-of-network provider" means a diagnostic
imaging provider, emergency care provider, facility-based
provider, or laboratory service provider that is not a
participating provider for a health benefit plan. The term
includes a group of out-of-network providers identified by one of
the following:
(A) a National Provider Identification Number;
(B) a group National Provider Identification
Number;
(C) an Employer Identification Number.
SECTION 2. Section 1467.087(e), Insurance Code, is amended
to read as follows:
(e) The losing party [parties] shall [evenly split and] pay
the arbitrator's fees and expenses not later than the 30th day after
the date the arbitrator provides the parties with the written
decision.
SECTION 3. 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 services 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 4. This Act takes effect September 1, 2025.