Ohio Senate Bill SB166

Ohio 2025-2026 Regular Session

• Introduced: 4/1/25

Caption

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.

Summary

SB 166 would amend Ohio law governing electronic health care claims and Medicaid billing to prohibit certain fees charged to providers for using electronic transaction systems. Under the bill, third-party payers could not impose any charge, fee, or other payment requirement, including withholding part of a payment, on a health care provider for electronic funds transfers or remittance advice transactions. The bill also makes a parallel change in the Medicaid statute so that the department of Medicaid, Medicaid managed care organizations, and the state pharmacy benefit manager could not charge providers fees or other payment requirements for electronic claims submitted through an approved electronic claims submission process. The bill preserves existing requirements that most Medicaid providers submit claims electronically and receive payment by electronic funds transfer, while keeping current exceptions for nursing facilities, ICF/IIDs, Medicaid managed care organizations, and other providers designated by rule. It also retains the ability of providers and third-party payers to agree to process non-electronic claims in cases of financial hardship or other extenuating circumstances. In effect, SB 166 would not eliminate electronic billing requirements; it would remove fee-based penalties or transaction charges associated with those electronic payment and claims systems.

Impact

SB 166 would amend Revised Code sections 3901.382 and 5164.46, affecting private health insurers, other third-party payers, Medicaid providers, Medicaid managed care organizations, and the state pharmacy benefit manager. The practical legal effect is to bar fee assessments tied to electronic claims submission, electronic funds transfers, and remittance advice transactions, while leaving the underlying electronic-claims framework in place. It would also repeal the existing versions of those sections and replace them with updated language reflecting the new prohibition on provider charges.

Sentiment

Based on the bill text and available context, the measure appears to be framed as a provider-relief and administrative-efficiency bill, with no recorded committee debate or votes in the provided materials. The overall sentiment is therefore best characterized as neutral to supportive in concept, since the bill aims to reduce billing-related costs for health care providers without changing the state’s broader move toward electronic claims processing.

Contention

The main policy tension is between maintaining mandatory electronic claims and payment systems and preventing payers from shifting transaction costs onto providers. Supporters would likely emphasize that providers should not be charged extra simply to comply with electronic billing requirements, especially when electronic submission is already required for most claims. Potential concerns could come from insurers, Medicaid administrators, or payment intermediaries that rely on existing fee structures or withholds to cover processing costs, though no specific opposition is documented in the provided record.