HB5036 - Relating to arbitration of certain out-of-network health benefit claims.

      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.