| 1 | 1 | | 89R19453 TYPED |
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| 2 | 2 | | By: Hagenbuch S.B. No. 2805 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | |
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| 6 | 6 | | |
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| 7 | 7 | | A BILL TO BE ENTITLED |
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| 8 | 8 | | AN ACT |
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| 9 | 9 | | Relating to arbitration of certain out-of-network health benefit |
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| 10 | 10 | | claims. |
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| 11 | 11 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 12 | 12 | | SECTION 1. Section 1467.001(6-a), Insurance Code, is |
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| 13 | 13 | | amended to read as follows: |
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| 14 | 14 | | (6-a) "Out-of-network provider" means a diagnostic |
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| 15 | 15 | | imaging provider, emergency care provider, facility-based |
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| 16 | 16 | | provider, or laboratory service provider that is not a |
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| 17 | 17 | | participating provider for a health benefit plan. The term includes |
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| 18 | 18 | | a group of out-of-network providers identified by one of the |
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| 19 | 19 | | following: |
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| 20 | 20 | | (A) a National Provider Identification Number; |
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| 21 | 21 | | (B) a group National Provider Identification |
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| 22 | 22 | | Number; |
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| 23 | 23 | | (C) an Employer Identification Number. |
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| 24 | 24 | | SECTION 2. Section 1467.087(e), Insurance Code, is amended |
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| 25 | 25 | | to read as follows: |
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| 26 | 26 | | (e) The losing party [parties] shall [evenly split and] pay |
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| 27 | 27 | | the arbitrator's fees and expenses not later than the 30th day after |
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| 28 | 28 | | the date the arbitrator provides the parties with the written |
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| 29 | 29 | | decision. |
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| 30 | 30 | | SECTION 3. The changes in law made by this Act apply only to a |
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| 31 | 31 | | health care or medical service or supply provided on or after |
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| 32 | 32 | | January 1, 2026. A health care or medical services or supply |
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| 33 | 33 | | provided before January 1, 2026, is governed by the law as it |
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| 34 | 34 | | existed immediately before the effective date of this Act, and that |
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| 35 | 35 | | law is continued in effect for that purpose. |
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| 36 | 36 | | SECTION 4. This Act takes effect September 1, 2025. |
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