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Providers of non-emergency medical transportation and nonmedical home care services will face extra state scrutiny before they can get paid by Medicaid, under a new anti-fraud bill passed by state lawmakers on Wednesday.

Senate Bill 315 requires these types of providers to support their payment claims through what’s called electronic visit verification. That can include GPS tracking when home aides clock in and out. This type of tracking is already required under federal law, but the state has struggled with implementation and compliance as families and providers have reported glitches with the system.

The bill contains various other measures meant to detect or crack down on fraud in Medicaid, the massive state healthcare program for poor and disabled Ohioans.

These include requiring state officials to use technology meant to detect suspicious billing activity, like when GPS location doesn’t match with billing information, and giving two elected offices – the state auditor and attorney general’s office – extra legal authority to demand records as part of their fraud investigations.

Republican lawmakers passed SB 315 on a fast track after a national conservative website published a series of reports last month that highlighted a disproportionately high volume of claims in the Columbus area for home health services. The Daily Wire’s series also identified several examples of people with questionable backgrounds being approved to bill Medicaid. 

State Rep. Brian Stewart, a Pickaway County Republican who leads a committee that negotiated the bill, said Democrats who were initially concerned that the bill would pose a barrier to people who rely on Medicaid ultimately agreed with what it was trying to accomplish. 

The bill received broad bipartisan support on Wednesday, clearing the House 85-10 and the Senate with a unanimous vote. It now heads to Gov. Mike DeWine’s desk for his signature. 

“I think it’s helped us do a better job of being able to catch fraud and make sure we have tighter controls. And a lot of the people that came in and said we’re concerned about this bill also said I’ve been defrauded as a recipient, so there’s clearly a middle ground there,” Stewart said.

The measure directs the state to set up a pilot program for the GPS tracking within a year and to implement it within 18 months.

SB 315 also contains a separate anti-fraud measure for the state’s Supplemental Nutrition Assistance Program. The bill requires the state to replace all of Ohio’s Electronic Benefits Transfer cards – the electronic payment cards people use to access state food aid – with cards containing a security chip like those found in modern debit and credit cards. EBT cards currently use magnetic strips, which are previous-generation technology susceptible to being “skimmed” and copied. 

The bill doesn’t set a deadline for the transition. The changes will happen as the state frantically tries to comply with a federal mandate to reduce program mispayments to avoid losing hundreds of millions in funding. 

The EBT and Medicaid elements of the bill ended up in the same proposal after Republican lawmakers merged them during a frantic week of lawmaking in what they expect to be their last legislative session until after the November election. 

Republicans backtrack on banning family caregivers

The bill notably doesn’t include a provision that drew hours of emotional testimony to the Statehouse over the past week. 

Reacting to a series of articles by The Daily Wire, Republicans initially moved to ban family members from providing non-medical care to their relatives, after the outlet described home health aid services, which are widely offered in state Medicaid programs across the country, as a way to pay people to hang out with their family.

In response, relative caregivers, including multiple mothers of children with severe disabilities, flooded state legislative committee hearings to describe their reality. They testified the provision would be life-altering for their family. 

One mom from the Cleveland area, Emily Lark, testified on June 3 that getting paid by Medicaid to serve as an aide to her seven-year-old daughter allowed her family to make ends meet while giving her daughter, Annika, a normal life that includes baseball and figure skating practice and art classes. Many families described family care as a solution to a shortage in the state pool of home health workers.

In response to a lawmaker’s question, Lark said during the committee hearing she doesn’t think there is a lot of fraud by family providers in the Medicaid program.

“If I was committing fraud, I’d have a wheelchair accessible vehicle for my kid. I’d have an accessible house. I’d have better clothes than this,” Lark said. “But we do it because we love our family members and we want to see them in our community.”

The testimony moved one Republican member of the House Medicaid Committee to tears. 

“I want to tell you coming in here means a lot,” said state Rep. Ron Ferguson, of Wintersville. “We have to address the fraud issue in this state. But what you said, we’ll take very seriously and make sure we get it correct.”

When Republicans unveiled an updated version of the bill on Monday, the ban on family caregivers was removed. And final changes approved by the House Finance Committee on Wednesday exempted live-in family caregivers from the GPS tracking requirements.

Stewart, a Republican who chairs the House Finance Committee, said lawmakers’ views changed as they learned more about the Medicaid system. He said it still could be a topic lawmakers address at a later date.

“I think there is still an appetite to take a look at whether we’re paying grandson to come cook soup for grandma,” Stewart said. “There are some things that have been raised over the past month that were worth taking a look at. But it’s hard to make that granular change without affecting the broader pool … It’s never been the intention that we would get into preventing family members from providing medical care.”

‘Government by YouTuber’

Democrats also went on a journey with the bill, going from initially questioning the need to pass laws in response to an out-of-state conservative outlet to getting on board with the final product. 

Cleveland State Rep. Bride Rose Sweeney, the ranking Democrat on the finance committee, Sweeney said Republicans agreed with many Democratic-suggested changes while taking out the worst parts of earlier versions of the bill.

Democrats voted for the bill even as some people with disabilities, their family members and other advocates warned GPS tracking of home aides posed a barrier for legitimate care. 

These advocates also described technology that glitched or areas of the state, particularly in Appalachia, that lacked consistent Internet or cell phone access. 

Sweeney said she’s comfortable that language in the bill, which also exempts those with developmental disabilities who receive home care through what’s called a waiver from GPS tracking, will not be a major impediment to those who rely on Medicaid. She said fraud in the system is driven by a lack of funding to pay for program oversight. 

And, she still heavily criticized the process behind the bill even as she came to vote for the final product.

Sweeney contrasted with the lengthy testimony the Medicaid committee allowed the Daily Wire reporter to deliver while limiting families to speak for a few minutes each on a constantly changing bill.

“This was an example of the legislature at its worst,” Sweeney said. “What happened was, one of the best quotes from an individual said this, ‘We’re in an experiment of government by YouTuber.”

In a House floor speech, Stewart described the legislative process as a “group project” that played out in public view. He said the resulting dialogue benefited the bill and public awareness of the realities of the program. 

“I think this process gave the public a better understanding of what people on Medicaid deal with,” he said.

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