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Minnesota Department of Human Services Early Intensive Development and Behavioral Intervention Manual
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EIDBI services

Page posted: 6/15/15

Page reviewed: 7/20/18

Page updated: 7/20/18

Legal authority

CMS-approved state plan amendment (PDF), Minn. Stat. §256B.0949

Overview

Every Early Intensive Developmental and Behavioral Intervention (EIDBI) service must both address the person’s medically necessary treatment goals and be targeted to develop, enhance or maintain the person’s developmental skills to improve his or her:

  • • Functional communication (receptive and expressive)
  • • Social or interpersonal interaction skills
  • • Interfering or complex behaviors
  • • Self-regulation
  • • Cognitive functioning
  • • Learning and playing skills
  • • Safety skills
  • • Self-care skills.
  • Every EIDBI service also must:

    Person-centered services

    Person-centered planning ensures EIDBI covered services:

  • • Respond to the identified needs, interests, values, preferences and desired outcomes of the person or the person’s legal representative as outlined in the comprehensive multi-disciplinary evaluation (CMDE) and individualized treatment plan (ITP)
  • • Respect the person’s rights, history, dignity and cultural background (see EIDBI – Rights and responsibilities)
  • • Allow inclusion and participation in the person’s community.
  • Covered services

    The EIDBI benefit covers the following services:

    For more information, see each service-specific page.

    Telemedicine

    A person may receive some EIDBI services via telemedicine. For more information, see EIDBI – Telemedicine services.

    Simultaneous services

    More than one provider may bill for these services at the same time:

  • • CMDE
  • • ITP development and progress monitoring
  • • Coordinated care conference.
  • Different levels of EIDBI providers may bill for these services at the same time:

  • • Intervention observation and direction
  • • Family/caregiver training and counseling.
  • Settings

    A person may receive EIDBI services in the following settings:

  • • Center
  • • Clinic
  • • His or her home or community environment (e.g., school)
  • • Office.
  • For more information, including setting definitions and documentation requirements, see EIDBI – Settings for EIDBI services.

    Coordination with other services

    A person’s EIDBI services must coordinate with all other services he/she receives to ensure he/she receives the most appropriate and effective combination to meet his/her needs.

    Educational/academic services

    EIDBI services are not intended to replace educational or academic services. EIDBI provider agencies and individual EIDBI providers must:

  • • Coordinate a person’s EIDBI services with all educational/academic services he or she receives or is eligible to receive
  • • Not represent EIDBI services as educational or academic services.
  • This does not prevent a person from receiving EIDBI services during school hours or on school grounds. However, if a person does receive EIDBI services during school hours or on school grounds, the person’s ITP must document why, including specific goals and objectives. For more information, see:

    Other Medicaid-funded services

    A person may receive EIDBI services in conjunction with other Medicaid-funded services, including, but not limited to:

    Non-covered services

    The EIDBI benefit does not cover:

  • • Provider training activities that do not meet the criteria for observation and direction
  • • Transportation for the person
  • • Group or individual intervention services delivered to one person by two or more EIDBI providers (of any level) at the same time.
  • The EIDBI benefit does not cover services that are:

    1. Conducted over the telephone, or via mail or email

    2. For the purpose of reporting, charting or record-keeping (except when this is integral to a covered CMDE or ITP service or a health service record)

    3. Not documented in the person’s health service record or ITP in the manner outlined by this policy manual or Minn. R. 9505.2175

    4. Primarily custodial, day care or respite

    5. Primarily recreational and not supervised by a medical professional (e.g., sports activities, craft activities, meal/snack time, trips to community activities tours, etc.)

  • • Exception: These activities may be covered if they are primarily for treatment and provided according to the person’s ITP
  • 6. The responsibility of a residential or program license holder (e.g., foster care providers) according to a service agreement or administrative licensing rules

    7. Not approved by the state’s medical review agent (except for services that do not require authorization)

    8. Including or replacing academic goals that are otherwise included in the person’s Individual Education Plan (IEP) or Individual Family Service Plan (FSP), as required under the Individuals with Disabilities Education Improvement Act of 2004

    9. Provided by:

  • • A parent, legal guardian or another person legally responsible for the person
  • • A person who does not meet the provider qualifications
  • 10. Provided in the following circumstances:

  • • In violation of Medical Assistance (MA) policy as outlined in Minn. R. 9505.0220
  • • To the general community (e.g., prevention and education programs)
  • • When the person is sleeping or napping
  • • Without the required supervision.
  • 11. Not provided (e.g., appointment no-shows)

    12. Not provided directly to a person who is present either physically or via interactive video, with the exception of the following services that do not require the person to be present:

  • • Coordinated care conference
  • • Family/caregiver training and counseling
  • • ITP development.
  • Termination of services

    The EIDBI provider agency may terminate a person’s EIDBI services if one of the medical necessity criteria is met for termination of EIDBI services.

    The provider must send notice of termination to the person or the person’s legal representative. The transition period begins when the person or the person’s legal representative receives notice of termination and ends on the last date of EIDBI services. Up to 30 days of continued service is allowed during the transition period. Services during the transition period must be consistent with what is documented in the ITP (see EIDBI – How to complete ITP and Progress Monitoring, DHS-7109).

    Transition plan

    The transition plan, documented in the person’s ITP, must include:

  • • Discharge criteria
  • • Protocols for changing service when medically necessary
  • • Information about how the transition will occur
  • • The time allowed to make the transition
  • • A description of how the person or the person’s legal representative will be informed of and involved in the transition.
  • Additional resources

    CBSM – Person-centered practices
    EIDBI – Eligibility for EIDBI services

    EIDBI – Medical necessity criteria

    MHCP Provider Manual – EIDBI – billing

    MHCP Provider Manual – EIDBI – service authorization

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