October 15, 2019
On June 14, 2019, Gov. Abbott signed SB 1264 into law. The bill amends the Texas Insurance Code to prohibit out-of-network health care providers from billing patients insured by state-regulated insurers or health maintenance organizations (HMOs) for the difference between what the patient’s insurer or HMO chooses to reimburse and that the out-of-network provider chooses to charge when providing emergency care on or after January 1, 2020. SB 1264 also amends the mediation process outlined in the Texas Insurance Code and provides for health benefit plan issuers and administrators to mediate disputes with out-of-network providers that are facilities, as well as providing a binding arbitration process that provides for health benefit plan issuers and administrators to resolve disputes with out-of-network providers that are not facilities. The Texas Department of Insurance is proposing new rules and amendments to current rules in order to comply with new requirements under SB 1264, including updating the agency’s mediation process, creating a new division to handle binding arbitration, describe explanation of benefit notices, and implement a benchmarking database. The agency is accepting written comments on those rules through 5:00 p.m. on October 28, 2019.
Information on the comment process, and Proposed Rules » SB 1264 »