HB3366 - Relating to mediation and arbitration between health benefit plan issuers or administrators and out-of-network health care providers.

  89R14083 SCL-F     By: Oliverson H.B. No. 3366       A BILL TO BE ENTITLED   AN ACT   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.