As Introduced

136th General Assembly

Regular Session S. B. No. 389

2025-2026

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.