Bill > HB5036

This bill modifies Texas insurance law regarding out-of-network health benefit claims by expanding the definition of "out-of-network provider" to include providers identifiable by National Provider Identification Numbers (NPI), group NPIs, or Employer Identification Numbers (EIN), which helps create a more comprehensive classification of providers outside traditional health plan networks. The bill also changes arbitration rules by specifying that only the losing party in an arbitration dispute must pay the arbitrator's fees and expenses, and mandates that these fees must be paid within 30 days of receiving the written arbitration decision. The legislative changes will only apply to health care services, medical services, or supplies provided on or after January 1, 2026, ensuring a clear transition period. The act is set to take effect on September 1, 2025, giving stakeholders time to prepare for the new regulations. This bill aims to provide more clarity and standardization in how out-of-network healthcare provider disputes are resolved and categorized.

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https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB5036