1.1 A bill for an act
1.2 relating to health insurance;
requiring coverage for augmentative and alternative
1.3 communication systems;
appropriating money;amending Minnesota Statutes 2024,
1.4 sections 256B.0625,
subdivisions 31, 31a; 256B.4914, subdivision 12; proposing
1.5 coding for new law in
Minnesota Statutes, chapter 62Q.
1.6 BE IT ENACTED BY THE
LEGISLATURE OF THE STATE OF MINNESOTA:
1.7 Section 1. [62Q.671]
COVERAGE FOR AUGMENTATIVE AND ALTERNATIVE
1.8 COMMUNICATION
SYSTEMS.
1.9 Subdivision
1.Definitions. (a) For the purposes of this section, the terms in
this
1.10 subdivision have the
meanings given.
1.11 (b) "Augmentative
and alternative communication system" means any electronic or
1.12 nonelectronic device and
related software and components, including mounting systems,
1.13 that assist a person
with severe expressive communication limitations to supplement existing
1.14 speech or replace speech
that is not functional.
1.15 (c) "Habilitation
services" means speech therapy rendered for congenital, developmental,
1.16 or medical conditions
that have significantly limited the successful initiation of normal
1.17 speech to assess,
select, and develop augmentative and alternative communication systems
1.18 and to provide training
in their use.
1.19 Subd. 2.Coverage.
(a) A health plan must provide
coverage for augmentative and
1.20 alternative
communication systems, including repair and replacement, determined by the
1.21 enrollee's prescribing
physician to be both medically necessary and the most appropriate
1.22 system to meet the
enrollee's communication needs.
2.1 (b) A health plan must
provide coverage for habilitation services determined by the
2.2 physician who
prescribed the augmentative and alternative communication device to be
2.3 medically necessary.
2.4 (c) A health plan must
not subject augmentative and alternative communication systems
2.5 and associated
habilitation services to separate financial requirements that apply only to
2.6 those benefits.
2.7 (d) A health plan must
not apply any quantitative limits to habilitation services associated
2.8 with a prescribed
augmentative and alternative communication system when the habilitation
2.9 services are ordered
by the prescribing physician.
2.10 Subd. 3.Prior
authorization. (a) A health plan may require prior authorization for
2.11 augmentative and
alternative communication systems and associated habilitation services
2.12 in the same manner and
to the same extent as prior authorization is required for any other
2.13 covered benefit.
2.14 (b) When performing a
utilization review for a request for coverage of augmentative
2.15 and alternative
communication systems and associated habilitation services, a health plan
2.16 company must apply the
most recent version of evidence-based guidelines recognized by
2.17 relevant clinical
specialists.
2.18 (c) A health plan
company must render utilization review determinations in a
2.19 nondiscriminatory manner
and must not deny coverage for augmentative and alternative
2.20 communication systems
and associated habilitation services solely on the basis of an
2.21 enrollee's actual or
perceived disability.
2.22 Subd. 4.Reimbursement.
(a) The commissioner of commerce must reimburse health
2.23 plan companies for
coverage under this section. Reimbursement is available only for coverage
2.24 that would not have been
provided by the health plan without the requirements of this
2.25 section. Augmentative
and alternative communication systems and associated habilitation
2.26 services covered by the
health plan as of January 1, 2025, are ineligible for payment under
2.27 this subdivision by the
commissioner of commerce.
2.28 (b) Health plan
companies must report to the commissioner of commerce quantified
2.29 costs attributable to
the additional benefit under this section in a format developed by the
2.30 commissioner. A health
plan's coverage as of January 1, 2025, must be used by the health
2.31 plan company as the
basis for determining whether coverage would not have been provided
2.32 by the health plan for
purposes of this subdivision.
3.1 (c) The commissioner
of commerce must evaluate submissions and make payments to
3.2 health plan companies
as provided in Code of Federal Regulations, title 45, section 155.170.
3.3 Subd.
5.Appropriation. Each fiscal year, an amount necessary to make
payments to
3.4 health plan companies
to defray the cost of providing coverage under this section is
3.5 appropriated to the
commissioner of commerce.
3.6 EFFECTIVE DATE.
This section is effective January 1, 2026, and applies to all health
3.7 plans offered, issued,
or renewed on or after that date.
3.8 Sec. 2. Minnesota Statutes
2024, section 256B.0625, subdivision 31, is amended to read:
3.9 Subd. 31.Medical
supplies and equipment. (a) Medical assistance covers medical
3.10 supplies and equipment.
Separate payment outside of the facility's payment rate shall be
3.11 made for wheelchairs and
wheelchair accessories for recipients who are residents of
3.12 intermediate care facilities
for the developmentally disabled. Reimbursement for wheelchairs
3.13 and wheelchair accessories for
ICF/DD recipients shall be subject to the same conditions
3.14 and limitations as coverage for
recipients who do not reside in institutions. A wheelchair
3.15 purchased outside of the
facility's payment rate is the property of the recipient.
3.16 (b) Vendors of durable medical
equipment, prosthetics, orthotics, or medical supplies
3.17 must enroll as a Medicare
provider.
3.18 (c) When necessary to ensure
access to durable medical equipment, prosthetics, orthotics,
3.19 or medical supplies, the
commissioner may exempt a vendor from the Medicare enrollment
3.20 requirement if:
3.21 (1) the vendor supplies only
one type of durable medical equipment, prosthetic, orthotic,
3.22 or medical supply;
3.23 (2) the vendor serves ten or
fewer medical assistance recipients per year;
3.24 (3) the commissioner finds that
other vendors are not available to provide same or similar
3.25 durable medical equipment,
prosthetics, orthotics, or medical supplies; and
3.26 (4) the vendor complies with
all screening requirements in this chapter and Code of
3.27 Federal Regulations, title 42,
part 455. The commissioner may also exempt a vendor from
3.28 the Medicare enrollment
requirement if the vendor is accredited by a Centers for Medicare
3.29 and Medicaid Services approved
national accreditation organization as complying with the
3.30 Medicare program's supplier and
quality standards and the vendor serves primarily pediatric
3.31 patients.
3.32 (d) Durable medical equipment
means a device or equipment that:
4.1 (1) can withstand repeated use;
4.2 (2) is generally not useful
in the absence of an illness, injury, or disability; and
4.3 (3) is provided to correct or
accommodate a physiological disorder or physical condition
4.4 or is generally used
primarily for a medical purpose.
4.5 (e) Electronic tablets may be
considered durable medical equipment if the electronic
4.6 tablet will be used as an
augmentative and alternative communication system as defined
4.7 under subdivision 31a,
paragraph (a) section 62Q.671. To be covered by medical assistance,
4.8 the device must be locked in
order to prevent use not related to communication.
4.9 (f) Notwithstanding the
requirement in paragraph (e) that an electronic tablet must be
4.10 locked to prevent use not as an
augmentative communication device, a recipient of waiver
4.11 services may use an electronic
tablet for a use not related to communication when the
4.12 recipient has been authorized
under the waiver to receive one or more additional applications
4.13 that can be loaded onto the
electronic tablet, such that allowing the additional use prevents
4.14 the purchase of a separate
electronic tablet with waiver funds.
4.15 (g) An order or prescription
for medical supplies, equipment, or appliances must meet
4.16 the requirements in Code of
Federal Regulations, title 42, part 440.70.
4.17 (h) Allergen-reducing products
provided according to subdivision 67, paragraph (c) or
4.18 (d), shall be considered
durable medical equipment.
4.19 (i) Seizure detection devices
are covered as durable medical equipment under this
4.20 subdivision if:
4.21 (1) the seizure detection
device is medically appropriate based on the recipient's medical
4.22 condition or status; and
4.23 (2) the recipient's health care
provider has identified that a seizure detection device
4.24 would:
4.25 (i) likely assist in reducing
bodily harm to or death of the recipient as a result of the
4.26 recipient experiencing a
seizure; or
4.27 (ii) provide data to the health
care provider necessary to appropriately diagnose or treat
4.28 a health condition of the
recipient that causes the seizure activity.
4.29 (j) For purposes of paragraph
(i), "seizure detection device" means a United States Food
4.30 and Drug
Administration-approved monitoring device and related service or subscription
4.31 supporting the prescribed use
of the device, including technology that provides ongoing
4.32 patient monitoring and alert
services that detect seizure activity and transmit notification
5.1 of the seizure activity to a
caregiver for appropriate medical response or collects data of the
5.2 seizure activity of the
recipient that can be used by a health care provider to diagnose or
5.3 appropriately treat a health
care condition that causes the seizure activity. The medical
5.4 assistance reimbursement rate
for a subscription supporting the prescribed use of a seizure
5.5 detection device is 60
percent of the rate for monthly remote monitoring under the medical
5.6 assistance telemonitoring
benefit.
5.7 EFFECTIVE DATE.
This section is effective January 1, 2026.
5.8 Sec. 3. Minnesota Statutes
2024, section 256B.0625, subdivision 31a, is amended to read:
5.9 Subd. 31a.Augmentative
and alternative communication systems. (a) Medical
5.10 assistance covers augmentative
and alternative communication systems consisting of
5.11 electronic or
nonelectronic devices and the related components necessary to enable a person
5.12 with severe expressive
communication limitations to produce or transmit messages or
5.13 symbols in a manner that
compensates for that disability as defined under section 62Q.671.
5.14 (b) Augmentative and
alternative communication systems must be paid the lower of the:
5.15 (1) submitted charge; or
5.16 (2)(i) manufacturer's suggested
retail price minus 20 percent for providers that are
5.17 manufacturers of augmentative
and alternative communication systems; or
5.18 (ii) manufacturer's invoice
charge plus 20 percent for providers that are not manufacturers
5.19 of augmentative and alternative
communication systems.
5.20 (c) Reimbursement rates
established by this purchasing program are not subject to
5.21 Minnesota Rules, part
9505.0445, item S or T.
5.22 EFFECTIVE DATE. This
section is effective January 1, 2026.
5.23 Sec. 4. Minnesota Statutes
2024, section 256B.4914, subdivision 12, is amended to read:
5.24 Subd. 12.Customization
of rates for individuals. (a) For
persons determined to have
5.25 higher needs based on being
deaf or hard-of-hearing, the direct-care costs must be increased
5.26 by an adjustment factor prior
to calculating the rate under subdivisions 6 to 9. The
5.27 customization rate with respect
to deaf or hard-of-hearing persons shall be $2.50 per hour
5.28 for waiver recipients who meet
the respective criteria as determined by the commissioner.
5.29 (b) For the purposes of this
section, "deaf and hard-of-hearing" means either:
5.30 (1) the person has a
developmental disability and:
6.1 (i) an assessment score which
indicates a hearing impairment that is severe or that the
6.2 person has no useful hearing;
6.3 (ii) an expressive
communications score that indicates the person uses single signs or
6.4 gestures, uses an
augmentative and alternative communication aid system, or
does not have
6.5 functional communication, or
the person's expressive communications is unknown; and
6.6 (iii) a communication score
which indicates the person comprehends signs, gestures,
6.7 and modeling prompts or does
not comprehend verbal, visual, or gestural communication,
6.8 or that the person's
receptive communication score is unknown; or
6.9 (2) the person receives
long-term care services and has an assessment score that indicates
6.10 the person hears only very loud
sounds, the person has no useful hearing, or a determination
6.11 cannot be made; and the person
receives long-term care services and has an assessment that
6.12 indicates the person
communicates needs with sign language, symbol board, written
6.13 messages, gestures, or an
interpreter; communicates with inappropriate content, makes
6.14 garbled sounds or displays
echolalia, or does not communicate needs.
6.15 EFFECTIVE DATE. This
section is effective January 1, 2026.
