1. Executive Summary
Ohio S.B. 315 bill modifies public program administration by mandating electronic validation systems, altering compliance tracking mechanisms, and increasing criminal penalties under the governing authority of the Ohio General Assembly.
2. What This Bill Would Do
[Sec. 3901.93] Requires the Superintendent of Insurance to establish and administer an all-payer claims database—a central database collecting health insurance claims from multiple payers. Currently, health insurance data collection is not unified under a comprehensive state-administered all-payer directory. This provision would mandate health plan issuers and other payers to submit health claims to the database in accordance with standard rules. Note: Implementation details are subject to agency rulemaking and require human review.
[Sec. 5101.5411] Mandates the Department of Job and Family Services to issue chip-enabled electronic benefit transfer cards for the Supplemental Nutrition Assistance Program. Currently, existing electronic benefit transfer cards do not possess electronic chip components. This provision requires that the Department of Job and Family Services begin issuing chip-enabled cards and replace existing cards under its ordinary replacement schedule.
[Sec. 2913.40] Enhances the baseline criminal classification for the offense of Medicaid fraud. Currently, the lowest classification for Medicaid fraud is a misdemeanor of the first degree. This provision would reclassify the lowest standard tier of Medicaid fraud as a felony of the fifth degree and mandate a mandatory minimum fine of one thousand dollars.
[Sec. 5164.40] Mandates that the Department of Medicaid require nonemergency medical transportation (NEMT) service providers—which provide transportation to medical services that are not emergency ambulance services—to utilize an electronic verification system. Currently, nonemergency medical transportation services do not operate under uniform electronic location verification reporting. This provision would require tracking of geographic location indicators during service delivery. Note: Implementation details are subject to agency rulemaking and require human review.
3. Who is Affected
Standing Committees of the House of Representatives and the Senate
How they are affected if the bill passes: They must meet jointly on an annual basis to conduct reviews of at least one-quarter of the operating Medicaid waiver components.
How their situation remains or changes if the bill does not pass: They operate under current legislative calendar schedules without mandated joint waiver review quotas.
Governing Section: Sec. 103.413.
Attorney General
How they are affected if the bill passes: The Attorney General shall investigate qualifying violations of law related to the Medicaid program or nursing homes when statutory triggering conditions are met, such as upon written request of specified state officials or upon independent awareness of improper activity. Implementation is assigned jointly to the Department of Medicaid and the Attorney General.
How their situation remains or changes if the bill does not pass: Their investigative authority remains bound by preexisting state coordination statutes.
Governing Section: Sec. 109.85.
Auditor of State
How they are affected if the bill passes: The Auditor of State may audit the accounts of Medicaid providers and issue subpoenas compelling books, records, accounts, and testimony relevant to their reviews.
How their situation remains or changes if the bill does not pass: Provider oversight operates under existing audit parameters.
Governing Section: Sec. 117.10.
Caregivers and Private Individuals Using Tracking Devices
How they are affected if the bill passes: They are prohibited from knowingly installing tracking applications or devices on another person’s property without consent, except for specific exempted groups such as legal guardians of minors, law enforcement, or designated caregivers of an elderly person or disabled adult with medical certification.
How their situation remains or changes if the bill does not pass: Electronic tracking utilization remains subject to existing general stalking and privacy laws.
Governing Section: Sec. 2903.216.
Individuals Committing Medicaid Fraud
How they are affected if the bill passes: They face elevated criminal penalties, including reclassification of baseline offenses to fifth-degree felonies and a mandatory fine of one thousand dollars.
How their situation remains or changes if the bill does not pass: Criminal sentencing guidelines remain at the first-degree misdemeanor baseline for low-value offenses.
Governing Section: Sec. 2913.40.
Payers (Health Plan Issuers, Medicare)
How they are affected if the bill passes: They must submit all health claims data to the Department of Insurance for inclusion in the newly established all-payer claims database. They face ongoing administrative compliance burdens associated with standardized data reporting.
How their situation remains or changes if the bill does not pass: They retain internal control of data reporting without submitting claims to a central state registry.
Governing Section: Sec. 3901.93.
Department of Insurance Subscribers
How they are affected if the bill passes: Individuals or entities seeking to access information in the database may be required to pay subscription fees, which are permitted to offset agency operational costs.
How their situation remains or changes if the bill does not pass: No centralized all-payer claims database registry or corresponding data subscription tier exists.
Governing Section: Sec. 3901.93.
Supplemental Nutrition Assistance Program (SNAP) Recipients
How they are affected if the bill passes: They will receive newly issued chip-enabled electronic benefit transfer cards to replace existing legacy cards. Implementation requires approximately $3.00 million in combined state and federal expenditures.
How their situation remains or changes if the bill does not pass: They continue to utilize standard electronic benefit transfer cards without integrated electronic security chip components.
Governing Section: Sec. 5101.5411.
Nonemergency Medical Transportation (NEMT) Service Providers and County-Administered NEMT Entities
How they are affected if the bill passes: They must use an electronic verification system that records location information during service delivery. This creates new software and reporting requirements.
How their situation remains or changes if the bill does not pass: They bill the state under existing mileage and service logs without mandated digital verification software.
Governing Section: Sec. 5164.40.
Home- and Community-Based Services (HCBS) Providers and High-Risk Providers
How they are affected if the bill passes: They face increased oversight burdens, including additional in-person reviews, site inspections, and prior authorization mandates—advance approval required before payment—for all personal care services. Additionally, the Department of Medicaid will cross-reference claims data using Electronic Visit Verification (EVV) systems—used to confirm services occurred.
How their situation remains or changes if the bill does not pass: Provider operations, visit validation, and authorization structures remain under preexisting baseline review cycles.
Governing Section: Sec. 5164.332 / Sec. 5164.402.
Medicaid Managed Care Organizations (MCOs)
How they are affected if the bill passes: They face additional reporting requirements, prepayment review restrictions, and mandated Attorney General approval requirements for specified program integrity actions. MCOs—private organizations that administer Medicaid benefits under contract—must also reconcile data with state monitoring tools.
How their situation remains or changes if the bill does not pass: MCOs operate under current administrative contracting terms without extra prepayment review and approval conditions.
Governing Section: Sec. 5167.03 / Sec. 5167.18.
Risk Contractors and Subcontractors
How they are affected if the bill passes: They face additional oversight obligations, including mandatory corrective action plans and compliance with new audit publication requirements.
How their situation remains or changes if the bill does not pass: Operational monitoring proceeds under existing state contract terms.
Governing Section: Sec. 5164.36 / Sec. 5164.57.
4. Existing Law vs. What Would Change
Current Law or Condition | What This Bill Changes |
Preexisting statute does not mandate a joint legislative committee review quota for specific percentages of Medicaid waiver components. | Sec. 103.413: Requires standing legislative committees governing Medicaid to meet jointly and evaluate one-quarter of all waiver components annually. |
Preexisting standard for low-value Medicaid fraud is classified as a misdemeanor of the first degree. | Sec. 2913.40: Reclassifies low-tier Medicaid fraud as a felony of the fifth degree and mandates a strict one-thousand-dollar fine. |
Health plan claims are reported to various individual registries, lacking a centralized state all-payer hub. | Sec. 3901.93: Requires the Superintendent of Insurance to establish a central all-payer claims database and forces payers to submit information. |
Supplemental Nutrition Assistance Program (SNAP) benefit cards do not contain mandated electronic chips. | Sec. 5101.5411: Requires the Department of Job and Family Services to transition all SNAP recipients to chip-enabled electronic benefit transfer cards. |
Nonemergency medical transportation services bill for covered rides without mandatory software logging global positioning system coordinates. | Sec. 5164.40: Mandates the use of an electronic verification system for all nonemergency medical transportation providers. |
Personal care services and high-risk provider visits are processed through standard billing without mandatory prior authorization for all visits. | Sec. 5164.332 / Sec. 5164.402: Mandates prior authorization for all personal care services and elevates the frequency of provider site inspections. |
5. Fiscal Impact Summary
Total estimated cost or savings over 10 years: The final fiscal note does not explicitly present an aggregated 10-year total dollar figure.
Which accounts or programs are affected and by what amount: * The Supplemental Nutrition Assistance Program (SNAP) card upgrade requires $3.00 million ($2.25 million from the state General Revenue Fund and $750,000 from federal funds).
The Department of Insurance will face startup costs and ongoing operating costs to create and manage the all-payer claims database. The fiscal note states that establishment and administration would cost millions of dollars but does not provide a precise Ohio estimate.
The Department of Medicaid will experience higher administrative costs to build global positioning tracking systems, expand EVV matching, and maintain a state monitoring dashboard.
The Department of Rehabilitation and Correction may experience a marginal increase in the prison population due to fraud reclassification, which it expects to absorb using existing staff resources.
Who bears the cost: State (General Revenue Fund, Fund 5540), federal matching funds, and private entities via potential database subscription fees.
Citation and Date: Ohio Legislative Service Commission, Final Fiscal Note & Local Impact Statement for S.B. 315, June 11, 2026.
6. Household Impact Matrix
Analysis for a household earning $35,000 to $100,000 (Median range for rural Ohio/Appalachian communities).
Metric | If Bill Passes | If Bill Fails or Status Quo Continues |
Household Overhead | Insufficient primary source data — pending official analysis. Note: The bill text and fiscal note contain no direct changes to household utility or tax rates. | Continuation of current healthcare cost trajectories and insurance premium rates under existing state regulatory frameworks. |
Market Stability | Health plan issuers must submit private data records to a state directory, altering proprietary data conditions. Nonemergency medical transportation companies must procure or interface with electronic logging systems, altering local operational standards. | Medical transport providers and private health plan issuers continue operating under individual business models without centralized data mandates. |
Mobility Check | The bill modifies compliance rules by requiring nonemergency medical transport verification, which explicitly states that the Department of Medicaid shall not deny a claim for payment for a service solely because the provider failed to comply with the electronic verification system if the service is medically necessary and satisfies all other conditions. | Existing Medicaid benefits verification procedures remain unchanged, maintaining current administrative frameworks. |
Local Government Impact | No local civil subdivisions are required to alter tax structures, as the Local Impact Statement procedure was declared not required. State agencies absorb direct administrative mandates. | Public program administration and department structures remain funded under existing operational allocations. |
7. Provisions Requiring Review
Sec. 3901.93(B)(2) contains delegation to agency rulemaking. Reason for review flag: The statute explicitly delegates the exact format and submission schedule of health claims data to the discretion of the Superintendent of Insurance via future rules. Recommended action: Verify eventual rules against Chapter 119 of the Revised Code.
Sec. 5164.40(B) contains conditional language and delegation. Reason for review flag: The section directs the Department of Medicaid to establish an electronic verification system but delegates the technical standards, claim validation procedures, and "good-cause exemptions" entirely to agency discretion. Recommended action: Monitor the implementation plan submitted to the General Assembly six months post-effective date.
8. What This Bill Does Not Do
The bill text does not contain provisions related to a total ban on family caregivers. Public discussion has referenced a caregiver ban in connection with this legislation. No such provision appears in Substitute Senate Bill 315 as evaluated in this final legislative text, which instead preserves standard caregiver tracking exemptions under specific medical certifications.
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