SF 1101

Introduction - 94th Legislature (2025 - 2026)

Posted on 02/21/2025 10:08 a.m.

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.

new text begin [62Q.671] COVERAGE FOR AUGMENTATIVE AND ALTERNATIVE
COMMUNICATION SYSTEMS.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For the purposes of this section, the terms in this
subdivision have the meanings given.
new text end

new text begin (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.
new text end

new text begin (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.
new text end

new text begin Subd. 2. new text end

new text begin Coverage. new text end

new text begin (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.
new text end

new text begin (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.
new text end

new text begin (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.
new text end

new text begin (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.
new text end

new text begin Subd. 3. new text end

new text begin Prior authorization. new text end

new text begin (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.
new text end

new text begin (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.
new text end

new text begin (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.
new text end

new text begin Subd. 4. new text end

new text begin Reimbursement. new text end

new text begin (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.
new text end

new text begin (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.
new text end

new text begin (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.
new text end

new text begin Subd. 5. new text end

new text begin Appropriation. new text end

new text begin 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.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2026, and applies to all health
plans offered, issued, or renewed on or after that date.
new text end

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 deleted text begin subdivision 31a, paragraph (a) deleted text end new text begin section 62Q.671 new text end . 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.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2026.
new text end

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 deleted text begin 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 deleted text end new text begin as defined under section 62Q.671 new text end .

(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.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2026.
new text end

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 new text begin either new text end :

(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 new text begin and alternative new text end communication deleted text begin aid deleted text end new text begin system new text end , 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.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2026.
new text end