Bill > A1509

Introduced Session

This bill establishes a binding arbitration process for when carriers and providers that are in the carrier's network of providers are in dispute. Specifically, when carriers and provider are in dispute over pricing and reimbursement and negotiations to resolve the dispute have failed, the bill allows either party to initiate binding arbitration to determine the terms of the provisions of the contract regarding pricing and reimbursement. Among the items the bill stipulates with regards to the arbitration is 1) that the arbitration be initiated by filing a request with the Department of Banking and Insurance; 2) the party requesting arbitration is to notify the other party that arbitration has been initiated and state its final offer before arbitration and in response, the other party is to inform the party initiating the arbitration of its final offer; and 3) the arbitrator's decision is to be one of the two amounts submitted by the parties as their final offers and is to be binding on both parties. Under the bill, if a dispute remains 60 days prior to the expiration of a contract between a carrier and provider and arbitration is not initiated, arbitration shall automatically be initiated. Reimbursement for health care services offered by the provider in the dispute are to continue without alteration until the first day of the next plan year. Thirty days prior to open enrollment of the current plan year in which there is a dispute between a carrier and a provider, notice that the provider in the dispute will be out-of-network as of the commencement of the next plan year is to be sent to the insured of the carrier.

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Roy Freiman (D)*, 

Introduced, Referred to Assembly Financial Institutions and Insurance Committee (on 01/13/2026)

Official Document