SB701 - Relating to mediation or arbitration of certain billing disputes between health benefit plan issuers or administrators and out-of-network facilities.

  89R727 CJD-F     By: Hughes S.B. No. 701       A BILL TO BE ENTITLED   AN ACT   relating to mediation or arbitration of certain billing disputes   between health benefit plan issuers or administrators and   out-of-network facilities.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Section 1467.081, Insurance Code, is amended to   read as follows:          Sec. 1467.081.  APPLICABILITY OF SUBCHAPTER.   Except as   provided by Section 1467.103, this [ This ] subchapter applies only   with respect to a health benefit claim submitted by an   out-of-network provider who is not a facility.          SECTION 2.  Section 1467.101, Insurance Code, is amended by   adding Subsection (c) to read as follows:           (c)     The following conduct constitutes bad faith   participation with respect to mediation under Subchapter B:                 (1)     failing to provide the material facts necessary to   conduct a meaningful mediation process; or                 (2)     failing to send to mediation a representative who   is authorized to negotiate on the party's behalf.          SECTION 3.  Subchapter C, Chapter 1467, Insurance Code, is   amended by adding Section 1467.103 to read as follows:           Sec.   1467.103.     REQUEST FOR ARBITRATION. (a)   Bad faith   participation with respect to mediation under Subchapter B by a   party to the mediation is grounds for the opposing party to request   arbitration under Subchapter B-1.           (b)  On a request for arbitration under Subsection (a):                 (1)     the out-of-network facility that is a party to the   mediation is considered an out-of-network provider for purposes of   the arbitration under Subchapter B-1; and                 (2)  the department shall:                       (A)  select an arbitrator; and                       (B)     require the arbitrator to make a   determination not later than the 30th day after the date the   arbitrator receives the information necessary to make the   determination under Section 1467.083.           (c)     Not later than the 30th day after the date an   arbitrator's written decision is provided to the parties under   Section 1467.088, the health benefit plan issuer or administrator   shall pay the out-of-network facility any additional amount   necessary to satisfy the award.          SECTION 4.  The changes in law made by this Act apply only to   a claim for health care or medical services or supplies provided on   or after January 1, 2026.          SECTION 5.  This Act takes effect September 1, 2025.