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Minnesota Department of Human Services Early Intensive Development and Behavioral Intervention Manual
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Coordinated care conference

Date posted: 6/15/15

Date reviewed: 2/21/17

Date updated: 2/21/17

Legal authority

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

Definition

Coordinated care conference: An EIDBI service that covers a meeting between the person, his or her family, EIDBI provider(s), other service professionals and/or other individuals the person/family requests.

Overview

DHS views the coordinated care conference as best practice to ensure that a person with complex health needs has access to and receives appropriate and necessary care, including medically necessary speech therapy, occupational therapy, mental health, human services and/or special education.

Either a CMDE provider or QSP may suggest a coordinated care conference, but it’s the person’s parent or legal representative’s decision to request the conference.

Eligible providers

The following MHCP-enrolled EIDBI providers may participate in and bill for the coordinated care conference:

If the following providers are enrolled with MHCP, they may also participate in and bill for the coordinated care conference:

  • • Advanced practice registered nurse (APRN)
  • • Physician.
  • Participants

    The coordinated care conference must include:

  • • The person’s parent(s)/legal representative
  • • A qualified supervising professional (QSP)
  • In addition to the providers eligible to bill for this service, the conference also may include:

  • • Personal care assistants (PCA)
  • • Family members or other primary caregivers
  • • Licensed professionals who work with the person or family or whose services may be needed (e.g., mental health)
  • • Rehabilitative services personnel
  • • School personnel
  • • Other providers or individuals the family requests.
  • Process

    The QSP should document each coordinated care conference in the Individual Treatment Plan (ITP) and Progress Monitoring, DHS-7109 (PDF). For more information, see EIDBI – How to complete ITP and Progress Monitoring, DHS-7109.

    Initial

    The initial conference should occur:

  • • After the person’s initial CMDE is complete
  • • In conjunction with the development of his or her initial individual treatment plan (ITP).
  • During the initial coordinated care conference, the participants:

  • • Review the CMDE results, including treatment options, parent/primary caregiver preferences and provider recommendations
  • • Discuss the parent or primary caregiver’s preferences for treatment modality, scope, intensity, frequency and duration
  • • Develop and coordinate the implementation of the person’s individual treatment plan (ITP) based on the parent/primary caregiver’s preferences and the CMDE results
  • • Identify the amount and type of parent/primary caregiver involvement in the person’s treatment
  • • Coordinate EIDBI services with other services the person and family receives
  • • Refer the person or family for other services, if needed.
  • Annual

    The annual coordinated care conference should occur in conjunction with the ITP progress monitoring update.

    In an annual coordinated care conference, the participants:

  • • Review the person’s progress toward goals and objectives documented in his or her ITP
  • • Document decisions or changes in the ITP
  • • Discuss other service updates, as applicable
  • • Continue to coordinate EIDBI services with other services the person and family receives
  • • Refer the person or family for other services, if needed
  • • Discuss transition planning.
  • Case notes

    The provider must document the coordinated care conference in the person’s case notes. For more information, see EIDBI – Health service records.

    Telemedicine

    If medically appropriate to the condition and needs of the person and family, family/caregiver training and counseling may be provided via two-way, interactive video. For more information, see EIDBI – Telemedicine services.

    Service authorization and billing

    For authorization and billing information, including provider and service limits, see:

    Additional provider responsibilities

    The QSP is responsible to:

  • • Arrange for an interpreter to attend the conference, if needed
  • • Coordinate and schedule the conference with the person and parent/legal representative
  • • Notify service professionals or other people who need to attend.
  • Additional resources

    EIDBI – Comprehensive multi-disciplinary evaluation (CMDE)
    EIDBI – EIDBI services

    EIDBI – Individual treatment plan (ITP) development and progress monitoring

    EIDBI – Settings for EIDBI services

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    © 2017 Minnesota Department of Human Services Updated: 2/21/17 3:44 PM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 2/21/17 3:44 PM