The bill amends Section 1467.054(a) of the Insurance Code to establish a timeline for out-of-network providers to request mandatory mediation for health benefit claims. Specifically, it stipulates that an out-of-network provider must request mediation not later than the 90th day after receiving an initial payment for a healthcare service or supply. The language also removes the previous phrasing that allowed for a request by either the out-of-network provider or a health benefit plan issuer or administrator without a specified timeline.

Additionally, the bill outlines that the changes will apply to healthcare services provided on or after the 30th day following the bill's effective date, as well as to services provided before that date if mediation is requested within 120 days of the bill's enactment. Services provided before the 30-day period that do not meet these criteria will continue to be governed by the previous law. The bill is set to take effect immediately upon receiving a two-thirds vote from both houses or on September 1, 2025, if such a vote is not achieved.

Statutes affected:
Introduced: Insurance Code 1467.054 (Insurance Code 1467)
House Committee Report: Insurance Code 1467.054 (Insurance Code 1467)