Bill Text: TX SB1298 | 2023-2024 | 88th Legislature | Introduced
Bill Title: Relating to requests for arbitration of certain billing disputes between health benefit plan issuers or administrators and out-of-network facilities.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2023-04-12 - Left pending in committee [SB1298 Detail]
Download: Texas-2023-SB1298-Introduced.html
88R11818 CJD-F | ||
By: Hughes | S.B. No. 1298 |
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relating to requests for 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 [ |
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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. Section 1467.103, Insurance Code, as added by | ||
this Act, applies only to a claim for health care or medical | ||
services or supplies provided on or after January 1, 2024. | ||
SECTION 5. This Act takes effect September 1, 2023. |