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, in the same manner as coverage under 
2.1 	section 256B.0625 and consistent with the Minnesota Health Care Programs Provider 
2.2 	Manual.
2.3 	(b) A health plan must provide coverage for habilitation services determined by the 
2.4 	physician who prescribed the augmentative and alternative communication device to be 
2.5 	medically necessary.
2.6 	(c) A health plan must not subject augmentative and alternative communication systems 
2.7 	and associated habilitation services to separate financial requirements that apply only to 
2.8 	those benefits.
2.9 	(d) A health plan must not apply any quantitative limits to habilitation services associated 
2.10 	with a prescribed augmentative and alternative communication system when the habilitation 
2.11 	services are ordered by the prescribing physician.
2.12 		Subd. 3.Prior authorization. (a) A health plan may require prior authorization for 
2.13 	augmentative and alternative communication systems and associated habilitation services 
2.14 	in the same manner and to the same extent as prior authorization is required for any other 
2.15 	covered benefit.
2.16 	(b) When performing a utilization review for a request for coverage of augmentative 
2.17 	and alternative communication systems and associated habilitation services, a health plan 
2.18 	company must apply the most recent version of evidence-based guidelines recognized by 
2.19 	relevant clinical specialists.
2.20 	(c) A health plan company must render utilization review determinations in a 
2.21 	nondiscriminatory manner and must not deny coverage for augmentative and alternative 
2.22 	communication systems and associated habilitation services solely on the basis of an 
2.23 	enrollee's actual or perceived disability.
2.24 		Subd. 4.Reimbursement. (a) The commissioner of commerce must reimburse health 
2.25 	plan companies for coverage under this section. Reimbursement is available only for coverage 
2.26 	that would not have been provided by the health plan without the requirements of this 
2.27 	section. Augmentative and alternative communication systems and associated habilitation 
2.28 	services covered by the health plan as of January 1, 2026, are ineligible for payment under 
2.29 	this subdivision by the commissioner of commerce.
2.30 	(b) Health plan companies must report to the commissioner of commerce quantified 
2.31 	costs attributable to the additional benefit under this section in a format developed by the 
2.32 	commissioner. A health plan's coverage as of January 1, 2026, must be used by the health 
3.1 	plan company as the basis for determining whether coverage would not have been provided 
3.2 	by the health plan for purposes of this subdivision.
3.3 	(c) The commissioner of commerce must evaluate submissions and make payments to 
3.4 	health plan companies as provided in Code of Federal Regulations, title 45, section 155.170.
3.5 		Subd. 5.Appropriation. Each fiscal year, an amount necessary to make payments to 
3.6 	health plan companies to defray the cost of providing coverage under this section is 
3.7 	appropriated to the commissioner of commerce.

3.8 	EFFECTIVE DATE. This section is effective January 1, 2027, and applies to all health 
3.9 	plans offered, issued, or renewed on or after that date.

3.10 	Sec. 2. Minnesota Statutes 2024, section 256B.0625, subdivision 31, is amended to read:
3.11 		Subd. 31.Medical supplies and equipment. (a) Medical assistance covers medical 
3.12 	supplies and equipment. Separate payment outside of the facility's payment rate shall be 
3.13 	made for wheelchairs and wheelchair accessories for recipients who are residents of 
3.14 	intermediate care facilities for the developmentally disabled. Reimbursement for wheelchairs 
3.15 	and wheelchair accessories for ICF/DD recipients shall be subject to the same conditions 
3.16 	and limitations as coverage for recipients who do not reside in institutions. A wheelchair 
3.17 	purchased outside of the facility's payment rate is the property of the recipient.
3.18 	(b) Vendors of durable medical equipment, prosthetics, orthotics, or medical supplies 
3.19 	must enroll as a Medicare provider.
3.20 	(c) When necessary to ensure access to durable medical equipment, prosthetics, orthotics, 
3.21 	or medical supplies, the commissioner may exempt a vendor from the Medicare enrollment 
3.22 	requirement if:
3.23 	(1) the vendor supplies only one type of durable medical equipment, prosthetic, orthotic, 
3.24 	or medical supply;
3.25 	(2) the vendor serves ten or fewer medical assistance recipients per year;
3.26 	(3) the commissioner finds that other vendors are not available to provide same or similar 
3.27 	durable medical equipment, prosthetics, orthotics, or medical supplies; and
3.28 	(4) the vendor complies with all screening requirements in this chapter and Code of 
3.29 	Federal Regulations, title 42, part 455. The commissioner may also exempt a vendor from 
3.30 	the Medicare enrollment requirement if the vendor is accredited by a Centers for Medicare 
3.31 	and Medicaid Services approved national accreditation organization as complying with the 
4.1 	Medicare program's supplier and quality standards and the vendor serves primarily pediatric 
4.2 	patients.
4.3 	(d) Durable medical equipment means a device or equipment that:
4.4 	(1) can withstand repeated use;
4.5 	(2) is generally not useful in the absence of an illness, injury, or disability; and
4.6 	(3) is provided to correct or accommodate a physiological disorder or physical condition 
4.7 	or is generally used primarily for a medical purpose.
4.8 	(e) Electronic tablets may be considered durable medical equipment if the electronic 
4.9 	tablet will be used as an augmentative and alternative communication system as defined 
4.10 	under subdivision 31a, paragraph (a) section 62Q.671. To be covered by medical assistance, 
4.11 	the device must be locked in order to prevent use not related to communication.
4.12 	(f) Notwithstanding the requirement in paragraph (e) that an electronic tablet must be 
4.13 	locked to prevent use not as an augmentative communication device, a recipient of waiver 
4.14 	services may use an electronic tablet for a use not related to communication when the 
4.15 	recipient has been authorized under the waiver to receive one or more additional applications 
4.16 	that can be loaded onto the electronic tablet, such that allowing the additional use prevents 
4.17 	the purchase of a separate electronic tablet with waiver funds.
4.18 	(g) An order or prescription for medical supplies, equipment, or appliances must meet 
4.19 	the requirements in Code of Federal Regulations, title 42, part 440.70.
4.20 	(h) Allergen-reducing products provided according to subdivision 67, paragraph (c) or 
4.21 	(d), shall be considered durable medical equipment.
4.22 	(i) Seizure detection devices are covered as durable medical equipment under this 
4.23 	subdivision if:
4.24 	(1) the seizure detection device is medically appropriate based on the recipient's medical 
4.25 	condition or status; and
4.26 	(2) the recipient's health care provider has identified that a seizure detection device 
4.27 	would:
4.28 	(i) likely assist in reducing bodily harm to or death of the recipient as a result of the 
4.29 	recipient experiencing a seizure; or
4.30 	(ii) provide data to the health care provider necessary to appropriately diagnose or treat 
4.31 	a health condition of the recipient that causes the seizure activity.
5.1 	(j) For purposes of paragraph (i), "seizure detection device" means a United States Food 
5.2 	and Drug Administration-approved monitoring device and related service or subscription 
5.3 	supporting the prescribed use of the device, including technology that provides ongoing 
5.4 	patient monitoring and alert services that detect seizure activity and transmit notification 
5.5 	of the seizure activity to a caregiver for appropriate medical response or collects data of the 
5.6 	seizure activity of the recipient that can be used by a health care provider to diagnose or 
5.7 	appropriately treat a health care condition that causes the seizure activity. The medical 
5.8 	assistance reimbursement rate for a subscription supporting the prescribed use of a seizure 
5.9 	detection device is 60 percent of the rate for monthly remote monitoring under the medical 
5.10 	assistance telemonitoring benefit.

5.11 	EFFECTIVE DATE. This section is effective January 1, 2027.

5.12 	Sec. 3. Minnesota Statutes 2024, section 256B.0625, subdivision 31a, is amended to read:
5.13 		Subd. 31a.Augmentative and alternative communication systems. (a) Medical 
5.14 	assistance covers augmentative and alternative communication systems consisting of 
5.15 	electronic or nonelectronic devices and the related components necessary to enable a person 
5.16 	with severe expressive communication limitations to produce or transmit messages or 
5.17 	symbols in a manner that compensates for that disability as defined under section 62Q.671.
5.18 	(b) Augmentative and alternative communication systems must be paid the lower of the:
5.19 	(1) submitted charge; or
5.20 	(2)(i) manufacturer's suggested retail price minus 20 percent for providers that are 
5.21 	manufacturers of augmentative and alternative communication systems; or
5.22 	(ii) manufacturer's invoice charge plus 20 percent for providers that are not manufacturers 
5.23 	of augmentative and alternative communication systems.
5.24 	(c) Reimbursement rates established by this purchasing program are not subject to 
5.25 	Minnesota Rules, part 9505.0445, item S or T.

5.26 	EFFECTIVE DATE. This section is effective January 1, 2027.

5.27 	Sec. 4. Minnesota Statutes 2024, section 256B.4914, subdivision 12, is amended to read:
5.28 		Subd. 12.Customization of rates for individuals.  (a) For persons determined to have 
5.29 	higher needs based on being deaf or hard-of-hearing, the direct-care costs must be increased 
5.30 	by an adjustment factor prior to calculating the rate under subdivisions 6 to 9. The 
6.1 	customization rate with respect to deaf or hard-of-hearing persons shall be $2.50 per hour 
6.2 	for waiver recipients who meet the respective criteria as determined by the commissioner.
6.3 	(b) For the purposes of this section, "deaf and hard-of-hearing" means either:
6.4 	(1) the person has a developmental disability and:
6.5 	(i) an assessment score which indicates a hearing impairment that is severe or that the 
6.6 	person has no useful hearing;
6.7 	(ii) an expressive communications score that indicates the person uses single signs or 
6.8 	gestures, uses an augmentative and alternative communication aid system, or does not have 
6.9 	functional communication, or the person's expressive communications is unknown; and
6.10 	(iii) a communication score which indicates the person comprehends signs, gestures, 
6.11 	and modeling prompts or does not comprehend verbal, visual, or gestural communication, 
6.12 	or that the person's receptive communication score is unknown; or
6.13 	(2) the person receives long-term care services and has an assessment score that indicates 
6.14 	the person hears only very loud sounds, the person has no useful hearing, or a determination 
6.15 	cannot be made; and the person receives long-term care services and has an assessment that 
6.16 	indicates the person communicates needs with sign language, symbol board, written 
6.17 	messages, gestures, or an interpreter; communicates with inappropriate content, makes 
6.18 	garbled sounds or displays echolalia, or does not communicate needs.

6.19 	EFFECTIVE DATE. This section is effective January 1, 2027.