Prohibit health insurance, Medicaid electronic claim fees

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.