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
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As Introduced
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;
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As Introduced
(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.
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