Relating to mediation and arbitration between health benefit plan issuers or administrators and out-of-network health care providers.
relating to mediation and arbitration between health benefit plan
issuers or administrators and out-of-network health care
providers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1467.051(b), Insurance Code, is amended
to read as follows:
(b) If a person requests mediation under this subchapter,
the out-of-network provider or the provider’s representative, and a
representative of the health benefit plan issuer or the
administrator, as appropriate, shall participate in the mediation.
Each party’s representative must have the authority to reach an
agreement in the mediation. The representative of a health benefit
plan issuer or administrator must have the authority to bind the
issuer or administrator to pay the amount in the agreement.
SECTION 2. Section 1467.054, Insurance Code, is amended by
adding Subsection (c) to read as follows:
(c) As soon as practicable after the mediator is appointed,
a health benefit plan issuer or administrator that is a party to the
mediation shall provide the mediator the issuer’s or
administrator’s complete contact information necessary to begin
the mediation, including contact information for the issuer’s or
administrator’s representative or scheduler.
SECTION 3. Subchapter B, Chapter 1467, Insurance Code, is
amended by adding Section 1467.057 to read as follows:
Sec. 1467.057. MEDIATOR’S RIGHT TO COMPEL ARBITRATION. (a)
Not later than the 45th day after the date that the mediator’s
report is provided to the department under Section 1467.060, the
mediator of a mediation for which there was no agreement may compel
arbitration under Subchapter B-1 to determine the amount due to the
out-of-network provider if the mediator determines that a party
failed to participate in the mediation in good faith.
(b) A party may not bring a civil action under Section
1467.0575 if the mediator orders arbitration under this section.
SECTION 4. Section 1467.087(e), Insurance Code, is amended
to read as follows:
(e) The parties shall evenly split and pay the arbitrator’s
fees and expenses. The fees may not exceed the maximum amount fixed
by commissioner rule. In fixing the maximum amount, the
commissioner shall determine a reasonable amount that fairly
compensates the arbitrator.
SECTION 5. 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 service 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 6. This Act takes effect September 1, 2025.
