Skip To: Main content|Subnavigation|
Minnesota Department of Human Services Early Intensive Development and Behavioral Intervention Manual
DHS Home CountyLink Home Manuals Home Bulletins
Advanced Search
Show/Hide Table of Contents  

Eligibility for EIDBI services

Page posted: 6/15/15

Page reviewed: 6/7/18

Page updated: 6/7/18

Legal authority

Minn. Stat. §256B.0949

Criteria

A person is eligible to receive Early Intensive Developmental and Behavioral Intervention (EIDBI) services if he or she meets all of the following criteria:

  • • Has been diagnosed with autism spectrum disorder (ASD) or a related condition
  • • Has had a comprehensive multi-disciplinary evaluation (CMDE) that establishes his or her medical need for EIDBI services
  • • Is enrolled in Medical Assistance (MA) or MinnesotaCare
  • • Is younger than age 21.
  • An MHCP-enrolled CMDE provider determines a person meets these eligibility criteria during the CMDE process.

    Autism spectrum disorder (ASD)

    Core symptoms of ASD include when the person has:

    1. Persistent challenges in social communication and social interaction across multiple contexts, demonstrated by challenges in all of the following:

  • • Social-emotional reciprocity (e.g., person has atypical social approach; reduced sharing of interests, emotions or affect; lack of starting or responding to social interactions including, but not limited to, conversations and play)
  • • Nonverbal communicative behaviors (e.g., person has atypical body language or gestures, poor eye contact, etc.)
  • • Developing, maintaining and understanding relationships (e.g., person has difficulty making friends, having interest in peers, sharing, imaginative play, etc.)
  • 2. Restricted, repetitive patterns of behavior, interests or activities, demonstrated by at least two of the following:

  • • Stereotyped or repetitive motor movements, use of objects or speech (e.g., person lines up toys, has echolalia, etc.)
  • • Ritualized patterns or routines (e.g., person demonstrates interfering behaviors when asked to transition from a preferred activity, insists on eating the same way or taking the same route every day, etc.)
  • • Highly restricted or fixated interests
  • • Hyper- or hypo-reactivity to sensory input or atypical interest in sensory aspects of the environment (e.g., person has adverse reaction to specific sounds, textures, smells or fascination with lights or movement, etc.).
  • Severity

    A person’s symptoms can range in severity. Severity is based on social communication impairments and restricted, repetitive patterns of behavior.

    Additional criteria

    Additional diagnostic criteria include the following:

  • • Symptoms must be present in the person’s early developmental period but might not fully be apparent until social demands exceed his/her current functioning or skills, or the person’s symptoms might be masked by learned strategies
  • • Symptoms cause clinically significant interference in a person’s social, occupational or other important areas of current functioning
  • • The person’s symptoms are not better explained by intellectual disability or global developmental delay (Note: A person may have an intellectual disability and ASD that co-exist).
  • For a full definition of ASD, see the current version of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM).

    Related conditions

    A related condition is a condition that is closely related to ASD and:

    1. Is severe and chronic
    2. Results in impairment of a person’s adaptive behavior and function similar to that of a person with ASD
    3. Requires treatment or services similar to those required for a person with ASD
    4. Results in challenges in the following symptom areas (similar to the symptoms of ASD):

  • • Social interaction and communication
  • • Restrictive, repetitive behaviors or hyper- or hypo-reactivity to sensory input (see examples in ASD section)
  • 5. May also include delays or a high level of support in one or more of the following related domains:

  • • Interfering or complex behaviors
  • • Cognitive functioning
  • • Expressive communication
  • • Receptive communication
  • • Safety
  • • Self-care
  • • Sensory processing or self-regulation.
  • Diagnosis

    A diagnosis of ASD or a related condition must:

  • • Be completed by a licensed physician, advanced practice registered nurse (APRN) or a mental health professional
  • • Include direct observations of the person and information from the person’s legal representative or primary caregiver.
  • Diagnostic criteria

    The diagnosing provider must use the current version of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnosis the person.

    Exception

    The diagnosing provider may choose not to use the current DSM criteria only if the person is younger than age 5 and has risk factors for ASD, such as:

  • • Prematurity
  • • Siblings diagnosed with ASD or other familial/genetic risk
  • • Presence of associated intellectual disability and language impairment
  • • Signs of ASD’s core deficits but not yet diagnosed.
  • In this case, the provider must use the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Childhood (DC: 0-3R or DC: 0-5R).

    Assessment tools

    To determine a diagnosis, the provider may consider additional assessment information, including:

  • • Specialized tests administered through special education evaluations by licensed school personnel
  • • Assessments from professionals licensed in the fields of medicine, speech and language, psychology, occupational therapy or physical therapy.
  • DHS encourages providers to use standardized assessment tools to diagnose ASD or related conditions and evaluate cognitive/intellectual, adaptive and sensory regulatory abilities. However, DHS does not require specific assessment tools.

    Comprehensive multi-disciplinary evaluation (CMDE)

    A comprehensive multi-disciplinary evaluation (CMDE) is a covered EIDBI service delivered by a qualified provider(s) to determine if a person has a medical need for EIDBI services. For more information about the CMDE and medical necessity determination process, see:

    Additional resources

    EIDBI – EIDBI services
    EIDBI – Overview of EIDBI providers

    Rate/Report this pageReport/Rate this page

    © 2018 Minnesota Department of Human Services Updated: 8/2/18 11:20 AM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 8/2/18 11:20 AM