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

Page posted: 6/15/15

Page reviewed: 2/17/17

Page updated: 2/17/17

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 medically stable and does not require 24-hour medical monitoring or procedures
  • • Is under age 21.
  • An MHCP-enrolled CMDE provider determines a person meets this eligibility criteria during the CMDE process.

    ASD and related conditions

    Autism spectrum disorder (ASD)

    Core symptoms of ASD include:

  • • Persistent deficits in verbal and nonverbal communication
  • • Persistent deficits in social interaction and relationships across multiple contexts
  • • Restricted, repetitive patterns of behavior, interests or activities.
  • A person’s symptoms may range in severity.

    Additional diagnostic criteria include the following:

  • • Symptoms must be present in the person’s early developmental period
  • • Symptoms cause clinically significant impairment in social, occupational or other important area of current functioning
  • • These disturbances 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 condition

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

  • • Is severe and chronic
  • • Results in impairment of a person’s adaptive behavior and function similar to that of someone with ASD
  • • Requires treatment or services similar to those required for a person with ASD
  • • Results in a person’s substantial functional limitations in three core developmental deficits of ASD: (a) social interaction, (b) non-verbal/social communication, (c) restrictive, repetitive behaviors
  • • May include deficits in one or more of the following related developmental domains: (a) behavioral challenges, (b) cognitive functioning, (c) expressive communication, (d) receptive communication, (e) safety and level of support needed, (f) self-care, and (e) sensory processing
  • • Is not attributable to mental illness as defined in Minn. Stat. §245.462, subd. 20, or an emotional disturbance as defined in Minn. Stat. §245.4871, subd. 15.
  • 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 under 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 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

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