Ohio House Health Committee - 6-3-2026

Chair Schmidt. Here. Vice Chair Dieter. Here. Ranking Member Simani. Here. Representative Baker. Here. Barhorst. Brownlee checked in. Craig. Grimm. Here. King checked in. Miller. Stewart. White. And Griss. Here. White's checked in.

Thank you, Madam Chairwoman. I really appreciate this. If I talk too fast this morning, I'm all hyped up on Proud Mary by Ike T. Turner. So that's been my motivator today. Chair Schmidt, Vice Chair Dieter, and Ranking Member Samani and members of the committee, thank you for the opportunity to provide testimony on House Bill 739. House Bill 739 requires the Ohio Department of Health to conduct a comprehensive assessment of its central warehouse operations and inventory management systems. At first glance, this may sound like a warehouse bill. It is not. It is a bill about readiness. And as we know, we had many, many challenges during COVID, and this bill is surrounded about protecting and administering to the citizens of Ohio without depending on the federal government. Ohioans expect their government to be prepared before a crisis occurs, not after. Whether we are dealing with a disease outbreak, civil weather event, public health emergency, supply chain disruptions, and another unforeseen event, Ohio must know what supplies it has, where they are located, whether they are usable, and how quickly they can be deployed. The warehouse is the backbone of that effort. If inventory cannot be located, tracked, verified, or deployed when needed, it does not matter how much was purchased or how much money was spent. Readiness depends on having a system in place that works when Ohioans are counting on them. House Bill 739 directs the Department of Health to conduct a complete review of the warehouse inventory and operations. The assessment includes inventory verification, identification of damaged and unusable products, warehouse organization, evaluation of storing practices, implementation of modern inventory management systems, and an independent review of overall readiness and operational efficiency. The goal is absolutely straightforward. We need to know what we have, where it is, what condition it is in, and whether our systems are capable of responding when Ohioans need assistance. This legislation is not being introduced because of a known problem. It is being introduced because responsible government plans ahead. The best time to identify weakness is before they become emergencies. The best time to improve systems is before they are tested. Ohio should have one of the premier public health warehouse and logistics operations in the country That the goal of this legislation We are the seventh largest state in the nation Our citizens deserve confidence that critical supplies are being managed properly, taxpayers' dollars are being protected, and the state is prepared to respond when called upon. This bill is about accountability. It is about preparedness. It is about protecting taxpayer investments. Most importantly, it is about making sure Ohio is ready when our citizens need it. Good government is not measured by how it performs when everything is going right. It is measured by how prepared it is when things are going wrong. I wanted to outline some things, Madam Chairwoman, what the bill does. It requires, of course, I talked about the comprehensive assessment. It reviews the inventory and stockpile accuracy. But what this bill does not do, it does not create a new state agency. It does not build a new warehouse. It does not expand government authority. It does not increase taxes. It does not impose new requirements on local health departments. It does not impose new requirements on hospitals, pharmacies, physicians, or private business. It does not change Ohio's public health emergency authorities. It does not require the purchase of additional stockpiles or inventory. and it does not create a permanent new spending program, and it does not create additional regulatory burdens. This is about accountability, modernization, preparedness, and the protection of our assets, and to be able to respond immediately for Ohio, not dependence on the federal government. And I'll take questions. Thank you.

Thank you, Chairwoman Schmidt. Thank you, Representative, for this bill. I really appreciate it. Just a housekeeping question in the very first line, to require the Department of Health to assess its central warehousing and to make an appropriation. There was not supposed to be any expense, so I was just wondering about that and if that could be removed from the bill.

Thank you, sir.

Thank you, Madam Chairwoman, for accommodating me. Now you can get to your committee. Thank you.

Yes.

Yes.

It's usually what I call him, too.

Chairwoman Schmidt, Vice Chair Dieter, Ranking Member Somani, and members of the House Health Committee, my name is Monica Hickel. I'm the Vice President of Advocacy for the Ohio State Medical Association. I appreciate you giving me the opportunity to come in and testify today in support of sub-Senate Bill 162. I have Dr. Mark Antacek with me. He's a longtime OSMA member and the current president of the Ohio Association of Rheumatology. I going to give a little bit of information about the issues surrounding the clawback statute that we currently have in Ohio but I going to go a little off script with my testimony because we have a handful of providers that are here testifying so I'm not going to get into the clinical aspects of the bill. I'll let them handle that. As many of you may know, takebacks occur when an insurance company retroactively denies or reclaim payments made to health care providers, oftentimes months or years after the payment claim was originally processed. This unprecedented take-back of an already paid claim creates an unnecessary financial framework and administrative stress and barriers to patient care, making them a tremendous burden for our health care providers. The time providers and their staff are forced to take to attempt to determine validity of these occurrences diverts significant time from patient care and results in a loss of critical practice revenue. We all know in the state of Ohio that our independent practices in particular and our practices and facilities in the rural areas are already operating under razor-thin margins, and any attempt to claw back payments that have already been pre-approved is really problematic for our practices that are just trying to service patients. Senna Bill 162 started out with significantly different language than what's in front of you today. The substitute version that you have represents months of negotiation and compromise with both the Department of Insurance and the health plans. Along with the sponsor, we worked really hard with the interested parties in the Senate to come to an agreement, after which point substitute Senate Bill 162 was able to move through the legislative process. I just want to note for the committee members that when we dealt with this bill in the Senate, there were no opponents on the bill. The bill, we went through an IP process in December and January of this year. The sub-bill was drafted in February. The parties agreed conceptually to the language in the sub-bill. Sub-bill was accepted in the Senate in March, voted out of the Senate in April. No changes have been made to the bill since the agreement was in place, and no amendments were kind of offered through the Senate process once the sub-bill was accepted. I give that caveat just so you all know the amount of work that went into this bill. We were really happy to offer the committee a product that had no opposition in the Senate. Usually when we deal with insurance-related issues, they can sometimes get contentious. Sometimes the business community weighs in. They are neutral on this bill in front of you today. And we were very appreciative of the Department of Insurance and the health plans for coming to the table and negotiating aspects of this bill with us. We think that it's a great product that's in front of you today. we would love this bill to pass a clean version of it, knowing that there was a lot of compromise that went into it. I know that there have been some amendments that have been shared with the committee. We believe that any amendments to the bill will go against the compromise that's in place. I also know, as everybody knows, that there is a ton of conversations around the Statehouse related to Medicaid fraud. And I commend Chairwoman Gross for the efforts that you've been going through with the Medicaid committee. It's such an important issue to tackle. I want to make sure committee knows that this bill does not apply to Medicaid. So we are not touching the Medicaid recoupment code section. I know that's already being discussed through the Medicaid committee and the process that we're going through with fraud. So I want to make sure that folks know that this doesn't apply to Medicaid. We thought about it originally, adding in Medicaid, but we know that Medicaid costs a lot of money, and we wanted to keep the bill as clean as possible. I also want to make sure that committee members know that current law, which we preserve in this bill, does allow a callback to happen without a time frame associated with it for allegations of fraud. So that's already in current law. We do not touch that in this bill because, again, we know how important that is to the General Assembly to keep us moving along a transparent process So again we believe the bill that in front of you does strike a balance between the issues that providers are experiencing and trying to just streamline the payment process so that they do not have to hire all the additional staff that they usually have to go through in order to process claims appropriately. So with that, I am going to turn it over to Dr. Antuchek. He'll get into some of the clinical aspects, and then I also know that we have other providers. So just wanted to kind of lay the committee out with the concepts in the bill and the process that we've gone through to start. So Dr. Antonchak, go ahead.

Are there any questions? Representative Dr. Simani.

Yeah, so through the chair to Dr. Smani. Ohio's current statute, as you all know, is 24 months, but as Doc said, sometimes the health plans go beyond that 24 months, which is a huge problem for us. Typically, providers are limited in their contract to 90 to 180 days in order to submit their claims. So they have a really tight time period to submit their claims, but the health plans on the back end have a significantly longer time to actually do an audit of those claims. Under the framework of this bill, we are changing the audit time period to 12 months instead of 24 months. That at least gives us, you know, one fiscal year to wrap up the books at the end of the year and give them more financial stability so that within 12 months they know that a payment won't be clawed back. Under the current law as well, you know, 24 months, if a payment gets clawed back, the provider tries to charge the patient. The patient's never going to pay a health care bill that's come in 24 months after the point of service. So it makes it really challenging for them. They end up eating the cost of a lot of those. So under the new framework of this bill, the original version that we introduced in the Senate did did tie providers and insurers to the same time period. So the same time period that a provider would have to submit a claim was the same time period that an insurer would have to do a callback of it. Through the compromise process, we ended up landing on 12 months, which we thought was was fairly fair. It is pretty reasonable when you look at the callback statutes around the country. 24 months is one that we all sort of agree to. I also forgot to mention another aspect of the bill that we added is electronic notification to a practice if they do get a clawback of a payment. What we uncovered during the IP process was that most the time that a clawback occurs in a practice setting, health insurers are hard copy mailing a letter to a practice, which tends to get lost in the mail a lot. And most practices are communicating electronically with their health plan. So we put a provision in the bill that there's that is If you typically communicate electronically with a health plan, then the clawback has to be electronically. They have to notify the practice electronically of a clawback. And then we added language in the bill that also gives a 60-day time period to appeal a potential clawback before it happens, so that instead of losing their money, they have a time period to kind of go through resubmitting any type of documentation that the health plans need. So there's a lot that goes into it. the time frame that providers have to submit a claim is significantly tighter than what we give health plans to do an audit of the claim.

Just to clarify, you said that the bill is for a 12-month clawback, not 24 months.

And then do you have any data on patients that change insurances in that period so that two years out they may be on a completely different insurance plan and how that impacts the practice then Yeah Chairwoman to the representative that is one of the reasons why we also wanted to address this bill because again if you have a clawback that happens 24 months after the time period you go to charge the patient for it

Thank you.

Thank you.

Chairwoman Schmidt, to the representative, those issues didn't come up through the IP process, so we haven't discussed them. From our perspective, the bill as drafted was really hard to get all of the different entities to be IPs in the Senate, which, as I mentioned, there was no opposition to the bill in the Senate. Health plans came in as IPs. To make additional changes to the bill now would be challenging for us because we feel like we've already compromised quite a bit on the bill. We had a really tight time frame to begin with. 24 months seems to be average around the country. And, again, for those allegations of fraud, the time frame doesn't apply. And so we feel like what we have brought in front of the committee is a pretty reasonable compromise, also considering the tight time frames that providers have to submit their claims.

Yep, sure.

Yeah, through the chairwoman to the representative. of again that language has been in the bill since the introduced version of it and issues around that language were not brought to our attention during the Senate we run into if we remove that language from the bill that essentially will allow a process where at any time during a contract that is live and valid a health plan can make a change to that contract so begs the question why would anybody even go into contract if their contracts can change all the time so for us that language was really important again to give the providers that transparency and that stability to know that once they enter into a contract with a health plan, that's not going to change during their contract time period. That creates a huge administrative burden to practices. When they're trying to keep track of all the different health plans that they in contract with if we allow a process where those contracts can change any time that creates a lot of chaos and a lot of administrative burden So I know that we have that bill in the Senate or in the House Insurance Committee This language is much more simplistic. It doesn't get at all the details that are included in the Adam Matthews bill that we're debating in insurance. And this is also just only relevant to payments, audits, and review of timeliness during the contract time period. So it doesn't say that they can't make any type of changes. but for those three situations, they would be prohibited from doing a change.

Thank you, Chair. Thank you so much. I just want to make a comment and then ask a question. I appreciate that you're in a private practice, and it's physician-owned. As we know, many physician practices have been gobbled up by the hospital system. So that leads into my next question. It would seem to me that it's probably a little difficult to keep the lights on when you don't know if you're going to lose your paychecks from two years ago. But I'm guessing you have a smaller legal department list, people that can fight these battles with insurance as opposed to the bigger conglomerates and the big hospital systems. What does that do to your costs and to your patients and your pass-through and all of that when you're just trying to keep the lights on and see patients and your specialty?

Representative Barhorst.

Through the chairwoman to the representative, they're usually a little longer. So typically a contract that our doc practices are in are somewhere between three to five years. So a year would be a super tight contract for a practice. I don't think those are overly common.

Are there any other questions of these witnesses? Thank you so much for your testimony. I'm now going to call on Matthew Tippett.

Welcome to the committee.

Thank you so much, sir, for your testimony. Are there any questions of this witness? Well, you did a great job. Thank you so much, and have a great day. I'm going to hope to get this name correct. Keith Vukasanovich? How bad did I mess that up?

That's all in the way you pronounce the Vuk, right?

Welcome to the committee.

Thank you so much for your testimony. Are there any questions of the witness? You got off easy. Thank you for coming. Thank you. David Wessels. Is David Wessels here Yes And I could pronounce your name You did thank you Welcome to the committee Thank you very much Chair Schmidt Vice Chair Dieter Ranking Member Samani and members of the House Health Committee

Thank you. Through the chair.

Chair Schmidt, to the representative, thank you for that question. So my understanding is that contractual differences will determine the amount of time. Some are going to be different or less than the statute within the state. But yes, on average, I would agree that they are similar to those that are placed upon medical providers. Thank you.

Hi. Thank you, Chair. Thank you for your testimony today. You had mentioned in your testimony some examples of retroactively denied claims or reclaimed payments. How often, if any, would you say your members or you experience those that are related to fraud, waste, or abuse?

Thank you. No follow-up.

Thank you, Chair Schmidt, for that question. And I appreciate the intelligence of persons collecting money directly, not from the insurance, but I don't question the intelligence of any therapists who are working through insurance contracts. I would say that it varies and differs based on the wide range of settings that Ohio physical therapists practice in. Some work in a large organization. Some work in private practice. Some are aligned with other providers, as you have mentioned, whether that be massage or chiropractor or others. And you can imagine those challenges even if clawbacks or takebacks or denials occurred in a short time window could be challenging to navigate But when we talking about years in the past to go back and try to find which provider who may not even work for that employer at that time that physical therapist may have moved on to another employment opportunity can be challenging So I'm not sure if I'm fully answering your question, but yes, we are contracted separately, so the denial or clawback would be specific to the physical therapy claim in that situation, but finding who the provider was, what exactly occurred in that situation, and the medical necessity documentation that would be needed to appeal that claim can be challenging years in the future. Thank you. Are there any other questions of the witness? Appreciate your time.

Thank you, Chair Schmidt. Vice Chair Dieter, Ranking Member Simani, my name is Dustin McKee, and I'm the CEO of the Ohio Psychological Association. We represent the 3500 plus licensed psychologists in the state of Ohio. You have my written testimony. I know you have a lot of witnesses. What I want to emphasize today is the workforce crisis we're experiencing in the behavioral health space. I came up in these halls talking a lot about the community mental health system through NAMI and different organizations like that. That's a lot of what we talk about here as far as mental health is concerned. But for the middle class, the backbone of our behavioral health provider workforce, it's a conglomeration of small businesses. They're small, independent therapists, psychologists, clinical social workers, and clinical counselors. And unless you're in this space, that's not really super apparent. So putting those providers at risk for two years for what typically is an administrative mistake by insurers doesn't make a ton of sense. This legislation is really low-hanging fruit for us to try and reduce some of the things that keep people from even starting to take insurance, let alone deciding that it's not worth the hassle. When I talk to my providers, to our psychologists, I very rarely hear about rates. Rates are what they are. But what I hear about when we talk about whether or not they've decided to take insurance is the hassle. Is it worth the hassle? And being at risk for a big clawback for two years oftentimes feels, especially to those entering the workforce, like something that's not worth the hassle. So I think it behooves us to stop the bleeding for the workforce that serves your loved ones, your family members that need access to care. We already have a hard time with panel adequacy for behavioral health providers.

Are there any questions of the witness?

Thank you.

Thank you. I will now call on Kelly O'Reilly. Welcome to the committee.

I do have a question before others.

It is my understanding that the sponsor of the bill is against these amendments and does not support these amendments. And I will add the comment that it is not my intention to change a bill when the sponsor is not in agreement of that.

All right. Let's see. Representative White.

Yes.

Madam Chair, to the member, thank you so much for the question. It is a very nuanced point, and so I'm happy to have the opportunity to address it. Under the current provision of the law fraud has an unlimited time frame for which plans can go back and recoup payments So in one month one year ten years if we discover fraud we are allowed to go back and recoup that under the current statute Nothing about that changes here. Waste and abuse have always been dealt with under the time limit for everything else. So waste and abuse was treated the same as a technical billing error, right? The wrong numbers being transposed, something like that. And so waste and abuse has heretofore had a 24-month look-back period or period for recoupment. Under the changes in this bill, if we don't add the words waste and abuse to put them in the category with fraud, making it that they can go back any time and recoup those dollars that are fraudulent, wasteful, or abusive, of we are actually lowering the time frame for which we can go after waste and abuse with this bill, which I think is counterintuitive given the dialogue that's happening in the Medicaid committee and more globally right now. I think we have a respected member of your own caucus who's testifying in Congress right now on this issue. So I think the last thing we want to do potentially is to take away the tool or limit the tools as it relates to waste and abuse that the plans have related to fraud. Because the three, when we look at the percentages of claims that are recovered due to fraud, it's about 2% of the cases, the recoupment of claims, whereas the waste and abuse recoupment is about 17%.

Thank you, Ms. O'Reilly.

Madam Chair, to the member, I would say that waste and abuse are more than just a billing error. And there are some definitions in Ohio Revised Code. As we discussed earlier, this bill doesn't apply to Medicaid, but there are Medicaid definitions in that regard. So it is beyond a billing error when it becomes waste and abuse. I'm a lawyer by training, and I will tell you that fraud cases are extraordinarily difficult to prove. And so as you look to prove a fraud case, you might not be able to make that last piece of evidence come together to prove fraud, because it is a very high evidentiary bar. And so ultimately what you can show is waste and abuse Now could it have ultimately been fraud Yes But you missing that last piece of evidence that you need to be able to pursue it as a fraud case So there a lot that falls under that umbrella. Ultimately, I would say that the real reason that we care about this is because any of the dollars that go out the door, whether it's fraud, waste, abuse, or billing errors perhaps that aren't even caught, right? If money goes out the door, that shouldn't have gone out the door, the result of that ultimately is borne by employers and their employees. Because whatever money goes out the door improperly, not for services, has to then ultimately be baked into the actuarial soundness of our rates that we file with ODI. And so those increases that don't improve the outcomes, the health outcomes of folks, are increasing the premiums for those employers and their employees. And so that's why we have to care about fraud, waste, and abuse, and not take away the tools that we need to have in the time frame to investigate those sometimes very complex cases. Thank you.

Absolutely.

Thank you. Through the chair, thank you for coming in. Every other person who's testified today has talked about the disruption to care and the difficulties of maintaining a practice when there's two years to take back claims and people tend to change their insurance companies. So what you're adding or what you're suggesting, how is that actually going to improve care or improve access for people to utilize insurance plans?

The examples that were given were not that the service wasn't provided. it was that they took the money back because some administrative thing changed. But also, you know, again, you can't insure people that aren't able to utilize the insurance. Even as Chair Schmidt said, she's paying out of pocket for her physical therapist. Not many people can afford to do that. Agreed. So if we are interested in people's health, if we're interested in providing health care, then we need to simplify the process. And we also need to simplify the process for the providers, for the physical therapists and physicians and psychologists, counselors, social workers that have all provided testimony that the clawbacks two years later makes it harder for them to even keep their doors open. So I think the compromise of 12 months makes a lot of sense when the providers have such a limited amount of time to actually put their billing in. Through the chair to the member, I agree with all of what you said,

Thank you. Representative Gross.

We would most certainly be an interested party. I think we could probably go down on the record as neutral. I would have to talk to my members about becoming a proponent because that's not a conversation I've had with them. I had a conversation with them about being an interested party in the Senate. because we were still working through the issues and because we had a good compromise on the main ingredients of the bill.

Thank you, Madam Chair, and thank you so much for being here. So my question kind of ties into what Representative White was talking about earlier. What definitions of waste and abuse would be used for the amendment? So through the chair to the member, thank you for the question.

office. Please do. Follow-up?

Thank you, Chair. just a couple things real quick you know I had pointed out I think my biggest concern is this the lines 12 to 3 just because we did have a very extensive IP meeting I know you touched on that in your testimony we had many many folks in the room for that just last week and a lot of dialogue passionate dialogue on both sides of it and so clearly there needs to be more dialogue on that before we're ready to change something like this so can you just explain a little bit further about the impact of changing this in this bill and what the benefits would be to take a pause on this piece specifically in here if we were to accept that amendment and what that could do for further conversations with 589?

I have one follow-up. One follow-up. I guess it's sort of a, not really a follow-up, but just another question. But I know ODI has been mentioned quite a bit here. They obviously, to my knowledge, that they actively organized IP meetings on this. Do you know why they aren't testifying today?

Any other questions? I would like to remind this committee that it is my policy that the sponsor of a bill has to agree or at least be neutral before any amendments are offered. That's only fair to the process of someone that has gone through an enormous amount of time to craft a bill, brought parties together. We are just re-looking at this bill. And these amendments came to me very quickly. I have been in discussion with the sponsor. The sponsor is not in favor of these amendments, and I want you to focus on what is in front of us and to make sure that what is being added doesn't compromise the original language in the bill. What looks like it's just a nothing-brainer really can undermine the bill. So, having said that, thank you for your testimony. Did you have a call?

Representative Barhorst.

Thank you for your testimony.

I will now, this concludes the second hearing on House Bill 162. Please. Now I will call on House Bill 945 for its first hearing. Will Representative White for a motion?

The amendment is in order. Would you please explain the amendment?

I think it's good.

Thank you.

Having said that, are there any objections to the amendments? Hearing none, they are accepted. Seeing none, I will now call on Representative White and Romer to give sponsor testimony.

on quality measurements, okay? These metrics needed for relicensure. Well, currently Hospices can opt out of this reporting requirement and just pay a fee to CMS. I don't think we really want to be allowing that when we need to be able to look at a dashboard and see the reporting and see really where everybody stands on these measures. An astounding 45% of Ohio's hospices opt out of doing this reporting. And that leaves families in the dark of figuring out what's the quality of the provider that I am choosing. So Bill, Representative Romer, we'll talk about the provisions of the bill and I'll chime in as needed, but we thank you for your time today.

Thank you. Were there any questions of the Representative Barhorst?

Thank you, Chair. Thank you, Representative. I think that we can have some of the experts in this space come in and give more detail, but I will tell you, the hospice licensing process with ODH, we're not changing that. So if you are licensed and the specifications of the care you provide And palliative care also is supposed to be six months And there end of life maybe you are admitted to a facility there some facilities in the state but a lot of the hospice care has become, you know, you're in the last six months of your life. And so I'm assuming, and there's people in the room that could probably answer that really well for me, but I'm assuming that it's one licensing process, and then that agency decides what kind of care they're providing.

Thank you. Thank you. Through the chair, thank you very much. This is a really important area, but one of the concerns I have that I've been hearing from other people who are in this space is that private equity is buying up a lot of the hospice entities, hospice. They're not called hospices.

So is there any exclusion or is there anything to say that private equity cannot be involved?

Thanks. Are there any other questions? Thank you so much. This concludes the first hearing on House Bill 945. I do have to pass the gavel on to Representative Dieter. I can assure you we did not plan the outfit today because we match. But I have another committee which I have votes in. So you're on, kid.

Thank you, Chair. I move to amend with Amendment L-136-3084-2 as the sub-bill.

The substitute bill requires soil analysis by the NESTS that is used as a primary system, authorizes the Board of Health to require soil analysis as well, authorizes the Board of Health to notify property owner that a soil analysis has not been conducted during the review of a newly created lot authorizes a Board of Health to create the notification statement described above and determine when issuance of the statement is appropriate through the rules requires a developer of a property owner of a newly created lot to provide written notice to the prospective purchaser stating that a soil analysis was not conducted and the the soil conditions may limit or prevent the installation of a sewer system. Requires the director to provide annual soil analysis training to local departments. Requires a board of health to conduct an educational assessment rather than an inspection within 12 months after installation at the time scheduled with the owner. Makes the development of the program for the administration of the maintenance permissive. Establishes registration guidelines for installers service providers and sewage haulers through the higher department of health provides a Board of Health from changing a fee related to the prohibits a Board of Health from changing a fee related to the board's duties and permits unless the board conducts a service under the STS laws and related rules, and in conclusion eliminates the local sewer treatment system appeals board and requires any appeal of the Board of Health decision to instead be heard before the governor appointed members of the Sewage Treatment System Technological Advisory Committee. Thank you.

Good morning. Thank you very much. My name is much easier to pronounce than other folks today, so that's good. Chair Schmidt, Vice Chair Dieter, Ranking Member Samani, and members of the House Health Committee, thank you for allowing me to provide proponent testimony today on Substitute House Bill 692, sponsored by Representative Pizzouli and Representative John. My name is Chad Brown, and I'm a member of the Board Directors for the Association of Ohio Health Commissioners, and I serve as the Lincoln County Health Commissioner. I would like to start by thanking the joint sponsors, Representative Pizzouli and Representative John, their staff, and the LLC staff, for working with us over the past several weeks on the substitute version of the bill that was accepted today. Substitute House Bill 692 aims to improve the law governing suies treatment systems in Ohio. The current law and regulations have been in effect for over a decade, and the common sense improvements offered in this substitute bill will maintain accepted public health practices while streamlining requirements that will make it easier to install and maintain suies treatment systems in Ohio. Conducting a soil analysis is a vital part of properly designing a suies treatment system. Doing so provides the greatest opportunity for a system to function properly and last a long time. Currently, two soil analyses are required to obtain a permit to install a sewage treatment system, one for a primary system that will be installed immediately and one for a secondary system. The secondary system is often evaluated years later under different sites or conditions, which makes the upfront analysis for a secondary system duplicative and limited in practical value. Substitute House Bill 692 removes the requirement for a soil analysis for a secondary system. Eliminating this requirement will cut the cost for property owners in half. The bill also removes the requirement for analysis when a new lot is created, further reducing costs and red tape for property owners. The result will be an expedited process that will allow the purchaser of a lot to have control of however that lot they're buying is developed. The bill would also remove the mandate for local health departments to implement a maintenance program for existing sewage treatment systems in their jurisdiction. These programs are often referred to as operation and maintenance programs or O&M programs. The bill will still allow local health departments to implement these programs, but the program can be designed to best suit their community's need. It will also reduce the administrative burden for the Ohio Department of Health regarding the oversight and auditing requirements of these programs. This provision will allow local entities to best serve their constituents through locally driven programs. Additionally, this legislation will prevent property owners from being forced to implement costly upgrades to existing sewage treatment systems. Instead, local health departments will be able to work with property owners to conduct incremental repairs. Rather than upgrading a system that can be repaired, property owners will have a variety of low-cost repair options that will maintain the integrity of their system. This approach will not only lower the cost to bring a system into compliance but increase the likelihood of repairs being made to failing sewage treatment systems Not only will property owners see reduced costs due to this provision but public health will also be protected due to necessary repairs being implemented. Another item of the bill will benefit contractors working around the state. Contractors are currently required to register in each jurisdiction in which they work to install and service sewage treatment systems. This legislation will eliminate this requirement and allow contractors to register with ODH for a single statewide registration. Doing so will result in cost savings for every sewage contractor in Ohio, make the registration process quicker, and decrease administrative costs at the local level. In closing, Substitute House Bill 692 represents a balanced approach to modernizing Ohio's sewage treatment system regulations. It reduces unnecessary costs and administrative burdens while preserving the core public health protection our communities rely on. By maintaining a local authority, encouraging practical solutions, and removing outdated requirements, this bill ensures sewage treatment systems are more likely to be installed, maintained, and repaired effectively. Chair Schmidt and members of the committee, thank you for allowing me to testify on Substitute House Bill 692, and I'm happy to answer any questions that you may have.

Good morning. Chair Schmidt, Vice Chair Dieter, ranking members, and members of the House Health Committee, thank you for the opportunity to provide proponent testimony on substitute bill, House Bill 692, sponsored by Representative Justin Pizzoli and Representative Marilyn John. My name is Justin Richa-Charr, and I currently serve as President of the Ohio Environmental Health Association, as well as Health Commissioner for Lorain County Public Health. I'm here today on behalf of OEHA and nearly 600 registered environmental health specialists and environmental health professionals across Ohio. Ohio's REHS workforce plays a critical hands-on role in ensuring safe design, insulation, and oversight of home sewage treatment systems. We are the frontline guardians of groundwater protection and residential wastewater safety in communities across the state. Home sewage treatment systems are a complex policy area. And these systems vary across our state. I want to thank Representative Pizzoli and Representative John on their willingness to engage and work collaboratively with OVHA to address a variety of concerns our organization had with the introduced version of the legislation. The substitute bill before you reflects meaningful improvements that strengthen public health protections while providing clarity and consistency for homeowners, contractors, and local health departments. The substitute bill's soil analysis provision ensure that the critical aspect of HSTS design is maintained while properly limiting when such analysis is needed for replacement areas or newly created lots. Additionally, the bill provides transparency for homeowners and prospective buyers by allowing clear notice when soil analysis has not been conducted on newly created lots. OHA further supports the bill's requirements for soil analysis training to local health departments, which strengthen technical competency and help address Ohio's workforce needs in this area. The substitute bill also provides an opportunity to engage with homeowners to increase their understanding of their HSTS through educational assessments. This approach allows REHS professionals to work directly with homeowners, explain system operation and maintenance, and prevent problems before occur. The bill provides statutory clarity on repairs versus replacements, ensuring that routine component failures can be addressed efficiently and streamlines the permitting process for registered contractors to create a consistent statewide framework and reduce local administrative burdens. Collectively, these changes create a more workable, balanced and protected framework for household sewage treatment systems in Ohio for both homeowners and public health. The substitute bill maintains the foundational safeguards that OEHA believes are essential while improving clarity, consistency, and efficiency for stakeholders. Again, OEHA is grateful for Rep. Pizzouli and Rep. John's thoughtful engagement on this legislation. Chair Schmidt and members of the House Health Committee, thank you for your time and consideration of our testimony. At this time, I'd be happy to entertain any questions.

Chair Schmidt, Vice Chair Dieter, Ranking Member Samani, and members of the House Health Committee, thank you for the opportunity to testify as an interested party to House Bill 692. My name is Matt Deaton. I'm a certified soil scientist, and I represent the Association of Ohio Pedologists as chair of our Legislative Engagement Committee. AOP is a non-profit scientific and educational organization dedicated to promoting the professional development of its members who are soil scientists in Ohio. What is a pedologist? We have a specialized training and perform work on behalf of many clients including homeowners, developers, private businesses, and many state and local governments. Our focus is to ensure the soil is proper for the development of many types of projects including roads, farms, home sites, campgrounds, wetlands, and yes, as it relates to the legislation, sewage treatment systems, or leach fields, as many people refer to them. We respect Representative Pizzouli and Representative John and understand many of the issues that urge them to introduce House Bill 692. We work in this space every day and understand the need to control cost, and especially in rural communities. We also know that there is a lack of clarity in the law or in the way the law is interpreted from one county to the next. We want to thank Representative Pizzouli for spending significant time with several of our association members to discuss key issues and allowing us to make suggestions to improve the bill. Also, I'd like to thank Representative John for spending time with me on the phone discussing key issues and concerns regarding this bill earlier this year. A soil evaluation provides a picture that shows how water reacts in a real-life setting. Soil is not just where the system is installed, but rather a critical component of the system itself. The soil must be able to filter and disperse the wastewater. The characteristics of the soil, such as depth, structure, and texture, decide the suitability of installing a septic system in any given area. We can almost always site a proper system in any given site if we know and understand what the soil on that specific site can do. We deal with failing systems every day and many of them fail prematurely because they were installed in soils in a way that they were never going to work due to the lack of site soils information Having had a chance to review the substitute bill, we feel that this is moving in the right direction, but there are still important changes that need to be made, and I'll highlight a few of our suggestions. First and foremost, it is important that we use proper terminology. Throughout the bill, it refers to a soil analysis. The proper term would be soil evaluation. A soil analysis is generally understood as a laboratory test that examines specific nutrients or chemical content. On the other hand, the term soil evaluation is consistent with our current Ohio Administrative Code, which defines a soil evaluation as considering certain aspects of the soil which can only be assessed in the field. Second, regarding the new lot split soil evaluations, We believe that there should be a minimum acreage threshold that necessitates the soil evaluation before approval is granted. Representative Pizzouli has firsthand experience with this on his own property. He mentioned that his six-acre parcel was limited to a three-bedroom home. Splitting a property without the soil evaluation could result in a parcel that cannot support a sewage system. Once a parcel is split, acquiring additional land becomes nearly impossible. I have numerous examples of attempting to install a system on old partials created before the current regulations where it almost always costs an additional $10,000 at a minimum to install a system on the property. If financing is involved, banks will require the soil evaluation to be conducted before closing as they want assurances that the land they are lending for is buildable. Incorporating this as a part of the split process could save people thousands of dollars. Third, regarding the issue of clarity in law or clarity in how the law is interpreted from one county to the next, we would suggest the creation of a rule advisory committee or perhaps tasking the current technical advisory committee to assist with rule review and update related to household sewage treatment systems. Finally, regarding cost. The average cost of a soil evaluation in Ohio is between 1 and 2 percent of the total cost of the sewage system. We believe that this is a small price to pay to ensure the system is properly sited, functions correctly, and serves as a valuable investment in the property for years to come. When homeowners invest tens of thousands of dollars in a septic system, they don't want to hope that it works. They want to know that it works. Siting a system without a soil evaluation is essentially installing something and hoping that it will work. While saving a few hundred dollars might seem like a small amount, it could quickly escalate into an additional $5,000, $30,000 for repairs or even a complete replacement to the homeowner. Madam Chair, thank you for the opportunity to testify, and I'll be happy to answer any questions you might have.

One sec, but Bradley. You mentioned a minimum acreage threshold. What would that be? Right now, most counties have somewhere between 20 and five. I would say probably the five-acre, five to seven-acre minimum. I talked to several counties Some counties started at five and they moved it up to seven because they were having issues with like flood zones and organic pockets and stuff like that And they felt like it needed to be just a little bit bigger, but five to seven on the minimum area of that. Okay. Thank you. Rep.

Through the chair to the rep. Yeah, it's a great question. Actually, a lot of times a lot of failures happen just because of lack of maintenance. if I'm being honest, and also, you know, put a place in an area that they shouldn't have been placed in the first place. I had a client of mine recently where they had put a system without any soil. They illegally did it. They put it in an area that was very wet, and the soil just couldn't absorb it. Other areas, I talked to a lady yesterday, and they haven't maintained their system. They've been there since 1980, and they hadn't pumped their tank, and now it's backing up into their house. and it's not a good situation. In situations like that, it's really poor maintenance. And so, you know, a properly sited system, a properly installed system, and a properly maintained system, in my opinion, should last a lifetime. And it should be a one-time thing.

Yeah, and the $5,000 is more of a repair site of things. The $30,000 would be more of a complete and total replacement of that system. That's why it was such a large, large thing. But yeah, it obviously it could it could impact the entire community if it's a if it's a large area of sewage that's seeping out. Maybe it's getting into the road ditch. Maybe it's getting into a creek. You know, depending on the level of that nuisance that's happening, it could definitely affect more than just that that one homeowner. Absolutely. Thank you.

Ranking Member Sabani. Thank you. Thank you so much for your testimony through the chair. I'm curious as to if you have data on waterborne illnesses, for example, Giardia, E. coli, there's a lot that are transmitted through fecal contamination if the sewage treatments leak or anything. Are there protections with this new bill? Are there ways that we can minimize that risk Through the chair to the member I don have data like that although I think there is protections through the bill where we not allowing those systems to go out You know, it's not a system that's connected to one of our waters of the state. It's a self-contained system where it's treated on site and dispersed on site. But, yeah, as far as the data of those waterborne illnesses, I do not have that. Follow-up? But is there more of a risk when we decrease standards that more of that may leak, that sewage may leak into the soil or into the area and increase that risk for infections? Yeah, absolutely. You know, anytime, you know, we reduce what we're doing and try to push a round peg into a square hole, you're creating more risk at that point. So, yeah, absolutely.

Thank you, Chair. I move to amend with Amendment 2607.

Yes. So this amendment, you may have recalled this from the operating budget. PACE providers assume presumptive eligibility costs when someone is deemed to be eligible for PACE. And then when they determine that they are not eligible for PACE, you know, then the person would go off the service, but PACE would assume all that risk and all of those costs. The issue is there's not really a good off-ramp for the PACE providers on how do you actually stop having the person on PACE. And so this amendment simply is an amendment we wanted to clear up the process. It doesn't change anything. It just makes it more clear for how the PACE operators take care of that. So it permits you to enroll the applicant following the first month while they're proceeding, just like before. And then mainly it allows the PACE organization to request the ineligible individual to pay the private rate once they are deemed ineligible. And then if they decline, you just follow the ODA's involuntary disenrollment process. So that's pretty much the amendment gist.