TMB Pulls Proposed Rule on Surprise Bills
By Joey Berlin


The Texas Medical Board (TMB) has withdrawn its proposed rules to implement pieces of the state’s new law introducing baseball-style arbitration on many out-of-network medical bills.

At its meeting Friday, TMB pulled down its rule proposal, saying in a statement that it “would not cover all providers under the statute.”

Senate Bill 1264, which will take effect for certain out-of-network medical care on Jan. 1, 2020, will allow payments for many medical bills to be decided using an arbitration system influenced by one the state of New York has used with success in recent years.

“The Board acknowledges regulatory authority will not extend to all possible providers covered by SB 1264,” TMB said in its statement. “The additional protections and notice sought by the statute would more appropriately come from definitions and descriptions of the statute that all appropriate regulatory agencies can propose rules for enforcement so that the rules ultimately apply to all providers in regards to billing issues.”

TMB also noted that it does have existing rule avenues for enforcing balance billing-related violations. It said it would “thoroughly investigate” licensed physicians accused of violating the new law.

“Moving forward,” TMB said, “the board will be analyzing related rulemaking of other agencies and will work with appropriate state agencies to complement any future rulemaking.”

After organized medicine helped modify the bill from its original, less medicine-friendly form, SB 1264 passed during this year’s legislative session. The Texas Department of Insurance was also engaged in rulemaking to accompany SB 1264 this fall and is expected to release its adopted rule soon.

Last Updated On

December 09, 2019

Originally Published On

December 09, 2019

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Balance Billing | Insurance | TMB

Joey Berlin

Associate Editor

(512) 370-1393

Joey Berlin is associate editor of Texas Medicine. His previous work includes stints as a reporter and editor for various newspapers and publishing companies, and he’s covered everything from hard news to sports to workers’ compensation. Joey grew up in the Kansas City area and attended the University of Kansas. He lives in Austin.

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