Ohio’s new Medicaid Program Integrity and Fraud Prevention Act, S.B. 315, takes effect Oct. 6, bringing a series of changes aimed at strengthening fraud prevention, provider oversight and payment integrity across the Medicaid program.
The law includes provisions related to provider enrollment, claims review, electronic visit verification, fraud detection, payment integrity and prior authorization. Not every provision will apply to every home health or hospice provider, but organizations participating in Ohio Medicaid should understand which changes affect their services and workflows.
Why it matters
S.B. 315 reflects Ohio’s broader focus on Medicaid program integrity and gives the Ohio Department of Medicaid additional tools and requirements that may affect provider enrollment, billing and compliance processes. Home health and hospice organizations should be prepared for increased scrutiny of Medicaid participation and claims activity as implementation moves forward.
What to do