Preparing for Senate Bill 1264 implementation

I want to thank all those who have helped our state get ready for Senate Bill 1264’s January 1 implementation. This is truly a transformative change to help end surprise medical bills. But our job isn’t done. We must continue to work collaboratively to ensure we achieve the consumer protections envisioned by the legislation.

As you’d expect with any change of this magnitude, SB 1264 brings challenges. It creates two distinct dispute resolution processes – mediation for facilities and labs and arbitration for physicians and other providers. It outlines 10 factors to be considered in arbitration, and it sets aggressive timelines to conclude cases.

Remember: Providers and health plans are still free to work directly with each other to set up agreements and dispute resolution processes tailored to their needs. SB 1264 creates new consumer protections, but it does not limit the ability of private parties to find other ways to resolve payment disputes.

We also ask for your help to lessen consumer confusion as we continue to resolve payment disputes for services delivered before January 1. Consumers may get balance bills for these services, and certain bills may be eligible for mediation under the state’s previous rules. And SB 1264 applies only to state-regulated plans.

At the Texas Department of Insurance, we’ll monitor SB 1264 implementation closely. There are several things you can do to help make this transition a success:

Stay engaged. We created a SB 1264 page on our website, and we’re planning webinars in January on mediation, arbitration, and the benchmarking database. You can sign up on the page to get an email alert when new events and information are posted.
Know the timelines. Under the SB 1264 process, once a mediator or arbitrator is assigned to a case, each party must pay half the cost.
Ask questions and report issues. We set up an email, IDR@tdi.texas.gov, just for this purpose.

As with any major, transformative piece of legislation, we understand issues may arise that aren’t addressed in the law or the rules of the state agencies involved. We are prepared to work collaboratively to resolve any issues. We appreciate your help and support as we work together to protect consumers.

Very truly yours,