Augmentative and alternative communication systems health insurance coverage required, and money appropriated.

A bill for an act

relating to health insurance; requiring coverage for augmentative and alternative

communication systems; appropriating money; amending Minnesota Statutes 2024,

sections 256B.0625, subdivisions 31, 31a; 256B.4914, subdivision 12; proposing

coding for new law in Minnesota Statutes, chapter 62Q.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

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[62Q.671] COVERAGE FOR AUGMENTATIVE AND ALTERNATIVE

COMMUNICATION SYSTEMS.

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Subdivision 1.

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Definitions.

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(a) For the purposes of this section, the terms in this

subdivision have the meanings given.

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(b) "Augmentative and alternative communication system" means any electronic or

nonelectronic device and related software and components, including mounting systems,

that assist a person with severe expressive communication limitations to supplement existing

speech or replace speech that is not functional.

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(c) "Habilitation services" means speech therapy rendered for congenital, developmental,

or medical conditions that have significantly limited the successful initiation of normal

speech to assess, select, and develop augmentative and alternative communication systems

and to provide training in their use.

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Subd. 2.

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Coverage.

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(a) A health plan must provide coverage for augmentative and

alternative communication systems, including repair and replacement, determined by the

enrollee's prescribing physician to be both medically necessary and the most appropriate

system to meet the enrollee's communication needs.

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(b) A health plan must provide coverage for habilitation services determined by the

physician who prescribed the augmentative and alternative communication device to be

medically necessary.

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(c) A health plan must not subject augmentative and alternative communication systems

and associated habilitation services to separate financial requirements that apply only to

those benefits.

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(d) A health plan must not apply any quantitative limits to habilitation services associated

with a prescribed augmentative and alternative communication system when the habilitation

services are ordered by the prescribing physician.

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Subd. 3.

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Prior authorization.

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(a) A health plan may require prior authorization for

augmentative and alternative communication systems and associated habilitation services

in the same manner and to the same extent as prior authorization is required for any other

covered benefit.

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(b) When performing a utilization review for a request for coverage of augmentative

and alternative communication systems and associated habilitation services, a health plan

company must apply the most recent version of evidence-based guidelines recognized by

relevant clinical specialists.

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(c) A health plan company must render utilization review determinations in a

nondiscriminatory manner and must not deny coverage for augmentative and alternative

communication systems and associated habilitation services solely on the basis of an

enrollee's actual or perceived disability.

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Subd. 4.

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Reimbursement.

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(a) The commissioner of commerce must reimburse health

plan companies for coverage under this section. Reimbursement is available only for coverage

that would not have been provided by the health plan without the requirements of this

section. Augmentative and alternative communication systems and associated habilitation

services covered by the health plan as of January 1, 2025, are ineligible for payment under

this subdivision by the commissioner of commerce.

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(b) Health plan companies must report to the commissioner of commerce quantified

costs attributable to the additional benefit under this section in a format developed by the

commissioner. A health plan's coverage as of January 1, 2025, must be used by the health

plan company as the basis for determining whether coverage would not have been provided

by the health plan for purposes of this subdivision.

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(c) The commissioner of commerce must evaluate submissions and make payments to

health plan companies as provided in Code of Federal Regulations, title 45, section 155.170.

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Subd. 5.

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Appropriation.

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Each fiscal year, an amount necessary to make payments to

health plan companies to defray the cost of providing coverage under this section is

appropriated to the commissioner of commerce.

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EFFECTIVE DATE.

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This section is effective January 1, 2026, and applies to all health

plans offered, issued, or renewed on or after that date.

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Sec. 2.

Minnesota Statutes 2024, section 256B.0625, subdivision 31, is amended to read:

Subd. 31.

Medical supplies and equipment.

(a) Medical assistance covers medical

supplies and equipment. Separate payment outside of the facility's payment rate shall be

made for wheelchairs and wheelchair accessories for recipients who are residents of

intermediate care facilities for the developmentally disabled. Reimbursement for wheelchairs

and wheelchair accessories for ICF/DD recipients shall be subject to the same conditions

and limitations as coverage for recipients who do not reside in institutions. A wheelchair

purchased outside of the facility's payment rate is the property of the recipient.

(b) Vendors of durable medical equipment, prosthetics, orthotics, or medical supplies

must enroll as a Medicare provider.

(c) When necessary to ensure access to durable medical equipment, prosthetics, orthotics,

or medical supplies, the commissioner may exempt a vendor from the Medicare enrollment

requirement if:

(1) the vendor supplies only one type of durable medical equipment, prosthetic, orthotic,

or medical supply;

(2) the vendor serves ten or fewer medical assistance recipients per year;

(3) the commissioner finds that other vendors are not available to provide same or similar

durable medical equipment, prosthetics, orthotics, or medical supplies; and

(4) the vendor complies with all screening requirements in this chapter and Code of

Federal Regulations, title 42, part 455. The commissioner may also exempt a vendor from

the Medicare enrollment requirement if the vendor is accredited by a Centers for Medicare

and Medicaid Services approved national accreditation organization as complying with the

Medicare program's supplier and quality standards and the vendor serves primarily pediatric

patients.

(d) Durable medical equipment means a device or equipment that:

(1) can withstand repeated use;

(2) is generally not useful in the absence of an illness, injury, or disability; and

(3) is provided to correct or accommodate a physiological disorder or physical condition

or is generally used primarily for a medical purpose.

(e) Electronic tablets may be considered durable medical equipment if the electronic

tablet will be used as an augmentative and alternative communication system as defined

under
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subdivision 31a, paragraph (a)
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section 62Q.671
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. To be covered by medical assistance,

the device must be locked in order to prevent use not related to communication.

(f) Notwithstanding the requirement in paragraph (e) that an electronic tablet must be

locked to prevent use not as an augmentative communication device, a recipient of waiver

services may use an electronic tablet for a use not related to communication when the

recipient has been authorized under the waiver to receive one or more additional applications

that can be loaded onto the electronic tablet, such that allowing the additional use prevents

the purchase of a separate electronic tablet with waiver funds.

(g) An order or prescription for medical supplies, equipment, or appliances must meet

the requirements in Code of Federal Regulations, title 42, part 440.70.

(h) Allergen-reducing products provided according to subdivision 67, paragraph (c) or

(d), shall be considered durable medical equipment.

(i) Seizure detection devices are covered as durable medical equipment under this

subdivision if:

(1) the seizure detection device is medically appropriate based on the recipient's medical

condition or status; and

(2) the recipient's health care provider has identified that a seizure detection device

would:

(i) likely assist in reducing bodily harm to or death of the recipient as a result of the

recipient experiencing a seizure; or

(ii) provide data to the health care provider necessary to appropriately diagnose or treat

a health condition of the recipient that causes the seizure activity.

(j) For purposes of paragraph (i), "seizure detection device" means a United States Food

and Drug Administration-approved monitoring device and related service or subscription

supporting the prescribed use of the device, including technology that provides ongoing

patient monitoring and alert services that detect seizure activity and transmit notification

of the seizure activity to a caregiver for appropriate medical response or collects data of the

seizure activity of the recipient that can be used by a health care provider to diagnose or

appropriately treat a health care condition that causes the seizure activity. The medical

assistance reimbursement rate for a subscription supporting the prescribed use of a seizure

detection device is 60 percent of the rate for monthly remote monitoring under the medical

assistance telemonitoring benefit.

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EFFECTIVE DATE.

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This section is effective January 1, 2026.

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Sec. 3.

Minnesota Statutes 2024, section 256B.0625, subdivision 31a, is amended to read:

Subd. 31a.

Augmentative and alternative communication systems.

(a) Medical

assistance covers augmentative and alternative communication systems
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consisting of

electronic or nonelectronic devices and the related components necessary to enable a person

with severe expressive communication limitations to produce or transmit messages or

symbols in a manner that compensates for that disability
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as defined under section 62Q.671
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.

(b) Augmentative and alternative communication systems must be paid the lower of the:

(1) submitted charge; or

(2)(i) manufacturer's suggested retail price minus 20 percent for providers that are

manufacturers of augmentative and alternative communication systems; or

(ii) manufacturer's invoice charge plus 20 percent for providers that are not manufacturers

of augmentative and alternative communication systems.

(c) Reimbursement rates established by this purchasing program are not subject to

Minnesota Rules, part
9505.0445
, item S or T.

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EFFECTIVE DATE.

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This section is effective January 1, 2026.

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Sec. 4.

Minnesota Statutes 2024, section 256B.4914, subdivision 12, is amended to read:

Subd. 12.

Customization of rates for individuals.

(a) For persons determined to have

higher needs based on being deaf or hard-of-hearing, the direct-care costs must be increased

by an adjustment factor prior to calculating the rate under subdivisions 6 to 9. The

customization rate with respect to deaf or hard-of-hearing persons shall be $2.50 per hour

for waiver recipients who meet the respective criteria as determined by the commissioner.

(b) For the purposes of this section, "deaf and hard-of-hearing" means
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either
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:

(1) the person has a developmental disability and:

(i) an assessment score which indicates a hearing impairment that is severe or that the

person has no useful hearing;

(ii) an expressive communications score that indicates the person uses single signs or

gestures, uses an augmentative
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and alternative
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communication
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aid
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system
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, or does not have

functional communication, or the person's expressive communications is unknown; and

(iii) a communication score which indicates the person comprehends signs, gestures,

and modeling prompts or does not comprehend verbal, visual, or gestural communication,

or that the person's receptive communication score is unknown; or

(2) the person receives long-term care services and has an assessment score that indicates

the person hears only very loud sounds, the person has no useful hearing, or a determination

cannot be made; and the person receives long-term care services and has an assessment that

indicates the person communicates needs with sign language, symbol board, written

messages, gestures, or an interpreter; communicates with inappropriate content, makes

garbled sounds or displays echolalia, or does not communicate needs.

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EFFECTIVE DATE.

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This section is effective January 1, 2026.

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