As Introduced

136th General Assembly

Regular Session S. B. No. 166

2025-2026

Senator Manning

To amend sections 3901.382 and 5164.46 of the Revised Code to prohibit fees for electronic claims submission by health insurer and the Medicaid program.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That sections 3901.382 and 5164.46 of the Revised Code be amended to read as follows:

Sec. 3901.382. (A) Beginning six months after the date specified in section 262 of the "Health Insurance Portability and Accountability Act of 1996," 110 Stat. 2027, 42 U.S.C.A. 1320d-4, on which a third-party payer is initially required to comply with a standard or implementation specification for the electronic exchange of health information, as adopted or established by the United States secretary of health and human services pursuant to that act, sections 3901.381, 3901.384, 3901.385, 3901.389, 3901.3810, 3901.3811, 3901.3812, and 3901.3813 of the Revised Code apply to a claim submitted to a third-party payer for payment for health care services only if the claim is submitted electronically. A

(B) A provider and third-party payer may enter into a contractual arrangement under which the third-party payer agrees to process claims that are not submitted electronically because of the financial hardship that electronic submission of claims would create for the provider or any other extenuating circumstance.

(C) No third-party payer shall impose any charge, fee, or other payment requirement, including through a withhold from payment, on any health care provider for electronic fund transfers or remittance advice transactions.

Sec. 5164.46. (A) As used in this section, "electronic claims submission process" means any of the following:

(1) Electronic interchange of data;

(2) Direct entry of data through an internet-based mechanism implemented by the department of medicaid;

(3) Any other process for the electronic submission of claims that is specified in rules adopted under section 5162.02 of the Revised Code.

(B) Not later than January 1, 2013, and except Except as provided in division (C) of this section, each medicaid provider shall do both of the following:

(1) Use only an electronic claims submission process to submit to the department of medicaid claims for medicaid payment for medicaid services provided to medicaid recipients;

(2) Arrange to receive medicaid payment from the department by means of electronic funds transfer.

(C) Division (B) of this section does not apply to any of the following:

(1) A nursing facility;

(2) An ICF/IID;

(3) A medicaid managed care organization;

(4) Any other medicaid provider or type of medicaid provider designated in rules adopted under section 5162.02 of the Revised Code.

(D) The department shall not process a medicaid claim submitted on or after January 1, 2013, unless the claim is submitted through an electronic claims submission process in accordance with this section.

(E) The department or its designee, including a medicaid managed care organization or the state pharmacy benefit manager established pursuant to section 5167.24 of the Revised Code, shall not impose any charge, fee, or other payment requirement, including through a withhold from payment, on any medicaid provider for electronic claims submitted pursuant to an electronic claims submission process under this section.

Section 2. That existing sections 3901.382 and 5164.46 of the Revised Code are hereby repealed.