Bill
A 9265
A 9265 authorizes penalties on subcontractors for failing to promptly, fairly, and equitably settle health-care claims and payments, boosting accountability for payors, providers.
Purpose and scope
- A 9265 would authorize the imposition of penalties on subcontractors that fail to adhere to the standards for prompt, fair, and equitable settlement of health-care claims and health-care service payments. The bill seeks to strengthen accountability for entities involved in processing and paying health-care claims by ensuring subcontractors comply with established settlement standards.
What the bill would do (key provisions)
- Authorize penalties: The bill provides for penalties to be imposed on subcontractors that do not meet the standards for prompt, fair, and equitable settlement of health-care claims and related payments.
- Standards reference: The penalties would apply to failures to adhere to the standards for promptness, fairness, and equity in the settlement of claims and payments for health-care services. Specific definitions of these standards would be detailed in the bill.
- Enforcement framework: The bill would establish (or reference) the enforcement mechanism for imposing penalties. The available information does not specify penalty amounts, procedural steps, or the agency responsible for enforcement.
- Compliance and remedies: The legislation would likely require subcontractors to comply with the standards and may address remedies or remedies for noncompliance, though exact provisions are not provided in the summary.
Who would be affected
- Subcontractors involved in health-care claims processing and payments (e.g., third-party administrators, outsourcing vendors, and other entities contracted by insurers or health-care payors).
- Health-care payors and insurers that rely on subcontractors for claim adjudication and payment.
- Health-care providers and patients who are affected by the timeliness and fairness of claim settlements and payments.
- Regulatory or oversight bodies responsible for enforcement, once designated in the statute.
Procedural/timeline aspects
- Status: Referred to the Insurance committee.
- Introduced: November 21, 2025.
- Legislative path: As a committee-referred bill, it would typically proceed to hearings, potential amendments, and floor consideration in the chamber of origin, followed by action in the other chamber if applicable. Specific timelines depend on the legislative calendar.
- Related legislation: Companion bill in the Senate is S 5323 (listed as a companion). There is also a S 9020 reference from a prior session, indicating related or prior proposals in the same policy area.
Notes and considerations
- The available information does not include specific penalty amounts, enforcement details, definitions of the standards, or implementation timelines. The full bill text would provide these details, including how penalties are assessed, who adjudicates penalties, and any exemptions or transitional provisions.
- The existence of companion bills (S 5323) suggests cross-chamber sponsorship and potential alignment with similar provisions in the Senate.
Impact snapshot
- If enacted, A 9265 could raise accountability for subcontractors in health-care claim processing, potentially improving the speed and fairness of settlements and payments, while imposing compliance costs and penalties for noncompliance.
Compiled from official sources — confirm details with the bill’s official record.
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