Texas House Bill HB 5036

Texas 2025 - 89th Regular

• Filed: 3/13/25

Caption

Relating to arbitration of certain out-of-network health benefit claims.

Summary

HB 5036 amends Texas Insurance Code provisions governing arbitration of certain out-of-network health benefit claims. The bill updates the definition of “out-of-network provider” to expressly include diagnostic imaging providers, emergency care providers, facility-based providers, and laboratory service providers that are not participating providers in a health benefit plan. It also clarifies that a group of such providers may be identified by a National Provider Identification Number, a group NPI, or an Employer Identification Number. The bill further changes the arbitration cost-allocation rule by requiring the losing party, rather than both parties splitting the costs, to pay the arbitrator’s fees and expenses within 30 days after the written decision is issued. The changes apply only to health care or medical services and supplies provided on or after January 1, 2026; services provided earlier remain governed by prior law. The act itself would take effect September 1, 2025.

Impact

HB 5036 would modify Chapter 1467 of the Insurance Code, which governs arbitration for certain surprise-billing or out-of-network health benefit disputes. The bill narrows and clarifies the statutory definition of covered out-of-network providers and changes the financial responsibility for arbitration from a shared-cost model to a loser-pays model. These changes affect health benefit plans, out-of-network providers, patients indirectly through dispute resolution outcomes, and arbitrators handling these claims.

Sentiment

Based on the available context, the bill appears to have been treated as a routine insurance committee measure with no recorded floor votes or committee debate in the provided materials. The absence of transcripts or vote data suggests there is no documented public controversy in the supplied record, though the subject matter indicates a policy choice about how arbitration costs should be allocated in out-of-network billing disputes.

Contention

The main point of potential contention is the shift from evenly splitting arbitrator fees and expenses to requiring the losing party to pay them, which could be viewed as increasing financial risk for one side of the dispute and potentially discouraging claims or defenses. Another possible issue is the bill’s expanded and more specific definition of out-of-network provider categories, which may affect which entities are subject to the arbitration process. No specific opposing viewpoints are recorded in the provided committee materials.