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As Introduced
136th
General Assembly
Regular
Session
S. B. No. 389
2025-2026
Senator Weinstein
To
enact
section
3902.65
of the Revised Code
regarding
insurance coverage for augmentative and alternative communication
tools.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section
1.
That
section
3902.65
of the Revised Code be
enacted
to
read as follows:
Sec.
3902.65.
(A)
As used in this section, "augmentative and alternative
communication tool" means any instrument, apparatus, equipment,
software application, or system designed or offered for the purpose
of supplementing, enhancing, or replacing speech for individuals with
significant expressive communication disabilities, including any of
the following:
(1)
Electronic speech-generating devices and voice output communication
aids;
(2)
Symbol and text-based communication boards, books, and displays;
(3)
Communication and text-to-speech software applications designed for
tablets, smartphones, or computers;
(4)
A tablet, smartphone, or computer on which communication or
text-to-speech software applications can be installed;
(5)
Switch-activated devices and adaptive hardware interfaces;
(6)
Eye-gaze systems and other alternative access methods;
(7)
All related accessories, mounting systems, carrying cases, protective
covers, switches, charging equipment, and interface devices necessary
for the operation of such communication tools.
(B)
On and after the effective date of this section, and notwithstanding
section 3901.71 of the Revised Code, a health benefit plan shall
provide coverage for augmentative and alternative communication tools
for a covered person twenty-two years of age or younger in accordance
with this section when prescribed, recommended, or provided by any of
the following:
(1)
A licensed speech-language pathologist;
(2)
A qualified assistive technology professional;
(3)
A physician;
(4)
Any other health care provider acting within that person's scope of
practice.
(C)
Except as provided in division (D) of this section, coverage provided
by a health benefit plan under division (B) of this section shall
include the full cost, up to six thousand dollars, of one medically
necessary augmentative and alternative communication tool.
(D)
If a speech-language pathologist determines and provides
documentation to a health plan issuer demonstrating that a person who
is eligible for coverage under this section is unable to achieve
effective communication using an augmentative and alternative
communication device covered under division (C) of this section,
despite appropriate evaluation, training, and use, a health benefit
plan shall cover the full cost, up to twenty thousand dollars, of an
enhanced augmentative and alternative communication tool.
(E)
The coverage required under divisions (C) and (D) of this section
shall include all of the following:
(1)(a)
Except as provided in division (E)(1)(b) of this section, replacement
of the device not less than once every five years;
(b)
A health benefit plan shall cover replacement of an augmentative and
alternative communication tool prior to the five-year replacement
period when a licensed speech-language pathologist documents that the
tool is no longer able to provide effective communication and that
repair or modification is not sufficient due to one or more of the
following circumstances:
(i)
Physical growth or anatomical changes affecting access or mounting;
(ii)
Changes in motor abilities or access method;
(iii)
Changes in communication needs or goals;
(iv)
Failure, degradation, or incompatibility of essential access
components;
(v)
Inability of the communication tool to support effective
communication despite appropriate training, adjustment, and repair.
(2)(a)
Any services necessary to evaluate, select, customize, fit,
configure, program, and train the covered person and, when
appropriate, the covered person's parent, guardian, or designated
caregiver in the effective use of the communication tool, as provided
by a licensed speech-pathologist or other qualified health care
provider acting within the provider's scope of practice;
(b)
With regard to coverage provided under division (D) of this section,
a health benefit plan shall also cover both of the following:
(i)
Advanced or alternative access methods;
(ii)
Specialized configuration, advanced access calibration, programming,
and training for the covered person and, when appropriate, the
covered person's parent, guardian, or designated caregiver, as
necessary to support effective communication.
(3)
The necessary repair, maintenance, and replacement of any damaged or
failed components of a covered augmentative and alternative
communication tool that are required to maintain effective
communication;
(4)
A temporary replacement or loaner communication tool sufficient to
ensure continuity of effective communication when a covered
augmentative and alternative communication tool is temporarily
unavailable due to repair or maintenance.
(F)
A health benefit plan shall not make coverage under this section
conditional upon ongoing usage-tracking data or quantitative use
thresholds.
(G)
Nothing in this section shall be construed as requiring coverage for
replacement of an augmentative and alternative communication tool
solely due to the availability of newer technology or updated device
models.