Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit
Review the EIDBI Benefit Policy Manual or take the EIDBI 101 training for providers for more information about the EIDBI benefit. Lead agencies should review the EIDBI benefit section of the Community-Based Services manual for more information.
Overview
The EIDBI benefit offers medically necessary services and supports to people under the age of 21 with autism spectrum disorder (ASD) or related conditions.
The purpose of the EIDBI benefit is to:
Eligible Providers
To provide, bill and receive payment for EIDBI services, a provider must:
Refer to the Overview of EIDBI Providers webpage in the EIDBI Benefit Policy Manual for more information. Refer to the Provider Basics section of the MHCP Provider Manual for general MHCP provider requirements.
Provider Enrollment
Follow the instructions on the Early Intensive Developmental Behavioral Intervention (EIDBI) Provider Enrollment Criteria and Forms webpage to enroll as an EIDBI provider with MHCP. All MHCP providers must register a MN–ITS account.
Eligible Members
A person is eligible to receive EIDBI services if the person meets all the following criteria:
Refer to the Eligibility for EIDBI services section of the EIDBI Benefit Policy Manual for more information.
Covered Services
The EIDBI benefit covers the following services:
Only eligible provider types may perform each service. Telehealth is an option for some EIDBI services. Refer to the EIDBI services section of the EIDBI Benefit Policy Manual for more information.
Noncovered Services
For a list of noncovered services, refer to the EIDBI services section of the EIDBI Benefit Policy Manual.
Access Services
EIDBI does not cover transportation and language interpreter services. As an MHCP provider, it may be covered through access services. Refer to the MHCP Provider Manual’s Access Services section for more information.
Service Authorization
Some EIDBI services require service authorization (SA). The authorization requirement safeguards against inappropriate and unnecessary use of health care services under state and federal law.
The SA allows qualified providers to bill and receive payment from MHCP after providing EIDBI services. However, having an approved SA does not guarantee MHCP payment. The provider must meet all other MHCP requirements to receive payment.
For information on transferring agencies or coordinating EIDBI with other services, review the EIDBI services section of the EIDBI Benefit Policy Manual.
Services that Require Authorization
The following services require authorization before service delivery:
Services that Do Not Require Authorization
The following services do not require authorization before service delivery, unless the service limit thresholds outlined on the EIDBI billing grid have been exceeded. All service limits apply to the person receiving services, not the provider.
Process
Information in this section pertains to fee-for-service MHCP members only. If the person is enrolled in a prepaid health plan (PPHP), contact the appropriate managed care organization for authorization requirements. When people have private insurance, follow the primary insurance’s authorization procedures and other applicable rules.
MHCP’s current medical review agent is Acentra Health (formally Keystone Peer Review Organization (KEPRO)). MHCP contracts with Acentra Health to process EIDBI service authorization requests. Before requesting an authorization for the first time, contact Acentra Health to let them know you are a new provider and give them your National Provider Identifier (NPI) number.
Note the following timelines in the EIDBI service authorization process:
Responsibilities
The comprehensive multi-disciplinary evaluation (CMDE) provider is responsible to:
The Qualified Supervising Professional (QSP) is responsible to:
In general, the EIDBI provider agency is responsible to:
Acentra Health will do the following within seven calendar days of receiving the CMDE:
Acentra Health will do the following within seven calendar days of receiving the ITP:
If Acentra Health puts the case in pending status in the Atrezzo portal and requests additional information:
Request Change to Approved Service Agreement
The provider may request an adjustment to an existing, approved service agreement on the ITP and submit to the medical review agent. Review the How to complete ITP and Progress Monitoring, DHS-7109 EIDBI Benefit Policy Manual webpage for instructions about how to complete this form.
Request Additional Authorization of Services
Complete and submit EIDBI Authorization Request (DHS-3806) (PDF) to request authorization for EIDBI services that exceed the service limit threshold outlined on the EIDBI billing grid (for example, additional CMDE in a calendar year). Refer to Instructions to complete the EIDBI Authorization Request form (DHS-3806A) (PDF) for instructions on how to complete and submit the form. DHS recommends a prior authorization request for these additional services; however, the medical review agent will accept authorization requests after the service is provided. Submitting a request for additional authorization of services does not guarantee an approval or MHCP payment. The medical review agent has seven calendar days from when the form is received to review and decide.
Transition and/or Discharge from an agency
The QSP should download and complete EIDBI transition and/or discharge summary (DHS-7109A) (PDF) electronically when a transition or discharge occurs. This form is optional but recommended to complete when a discharge or transition occurs. Review the How to complete ITP and Progress Monitoring, DHS-7109 EIDBI Benefit Policy Manual for instructions on how to complete the form. Submit DHS-7109A to the medical review agent or the person’s corresponding health plan. For changes to an existing service agreement, upload the form to the approved case. Be sure to adjust the units to reflect the requested changes. The medical review agent has seven calendar days from when the form is received to review and make the requested changes.
Resources
Contact the Acentra Health provider call center at 866-433-3658 or 612-354-5589 for the following:
Refer to the Acentra Health/MHCP website, EIDBI Atrezzo Provider Portal Training (PPT), Atrezzo Provider Portal—Create Case Training Video and the Authorization section of the MHCP Provider Manual for more information.
Refer to the Comprehensive multi-disciplinary evaluation (CMDE) and the Individual treatment plan (ITP) development and progress monitoring EIDBI Benefit Policy Manual webpages for instructions on how to complete the CMDE and ITP forms.
Refer to Authorization under Provider Basics in the MHCP Provider Manual for more information about authorization.
Refer to the Early Intensive Developmental and Behavioral Intervention (EIDBI) Compliance and Program Integrity Guide (DHS-8632) (PDF) for important links to training and tools to support compliance with EIDBI program standards. Review this document to ensure your agency is aligned with current expectations and best practices.
Billing
Refer to the Billing Policy Overview section of the MHCP Provider Manual for general MHCP billing requirements.
Refer to the EIDBI Billing Grid for:
Refer to the MHCP Fee Schedule for the most current rate information.
Billing Requirements — Continuous Service Delivery and Provider Breaks
EIDBI is a fee-for-service Medicaid benefit. Providers may only bill for time during which medically necessary EIDBI services are actively being delivered by qualified providers. Billing must stop immediately when service delivery stops and may resume only when service delivery continues. This requirement applies regardless of the reason for the interruption.
Provider Breaks
If an EIDBI provider takes a break of any kind — including restroom use, eating or snack breaks, personal or work-related phone calls, completing administrative tasks (such as emails or scheduling), or stepping away to retrieve supplies — billing must be paused for the duration of the break. Providers may not bill for any time period the provider is not physically present and actively engaged in delivering EIDBI services.
A provider billing time used for breaks constitutes inaccurate billing and may result in payment recoupments, audit findings, or additional program integrity actions from DHS or other auditors. Employment accommodations or scheduling considerations are not authorized for billing time when Medicaid-covered services are not being delivered; any break or accommodation must be managed through flexibly scheduled time and cannot be billed unless covered services are actively being provided.
Requirements for Continuous Service Delivery
Documentation must reflect continuous intervention, provider presence, and purposeful therapeutic activity throughout the billable period. A provider who is not present in the session is not considered to be implementing the treatment plan, supervising the child, collecting data, modifying protocols, directing a session, or providing caregiver training, and therefore the time is not billable.
Appropriate Use of Midpoint Billing
The midpoint billing rule may be used only when service delivery remains continuous, and the provider is still actively providing intervention, even during short child-led or naturalistic pauses. Examples of allowable continuous service include brief periods of:
The provider must remain engaged in therapeutic activity during these intervals, such as:
These activities maintain the continuity of service required for midpoint rounding. Stepping away from the session for any nonbillable activity does not meet the requirements for continuous service and is not billable under EIDBI.
Billing when a member has primary commercial insurance
EIDBI providers are not required to bill a member’s commercial insurance before billing Medicaid. MHCP or the MCO will seek reimbursement from third parties whenever claims have been paid for which there is Third Party Liability. This is also referred to as the “pay and chase” method. This “pay and chase” process applies to both fee-for-service and managed care members.
The service must be provided first and then coordination of payment with the liable third party can occur, according to contract requirements and federal regulations.
However, if an EIDBI agency receives payment from another source, third-party liability reporting is still required.
Submitting Claims
To submit claims for EIDBI services:
A claim submission must include:
All claims submitted for any services delivered by a Level III provider must have the UMPI or NPI number of the rendering provider.
When submitting claims for EIDBI services:
Tribal providers should refer to Tribal and Federal Indian Health Services in the MHCP Provider Manual for more information.
Telehealth
Certain EIDBI services are eligible to be provided via telehealth. Services provided via telehealth have the same service thresholds, reimbursement rates and authorization requirements as services delivered in person. When services have been delivered via telehealth, the correct place of service must be provided. MHCP does not reimburse for connection charges, or origination, set-up or site fees.
Refer to:
Refer to Billing Policy Overview under Provider Basics in the MHCP Provider Manual for more information.
Managed Care Organizations
EIDBI provider agencies that are enrolled in a health plan must follow the managed care organization’s rules and guidelines to bill, obtain authorizations and enroll with the health plan. Refer to the Managed Care Organizations (MCOs) and Prepaid Health Plans (PPHPS) section for more information. Refer to the EIDBI MCO Contact Information Grid (PDF) for MCO contact information.
MCOs may require that the CMDE and ITP be submitted together for authorization.
MCO Enrollment of EIDBI Providers
MCOs must use the DHS weekly EIDBI enrollment report, Provider Enrollment (PECD) file, or the DHS Minnesota Provider Screening and Enrollment portal to identify and credential all Level 1, 2, 3, and QSP providers. After a provider submits a clean application, the MCO must decide within 45 days, unless there is a significant quality or safety concern that requires more review. If DHS shows an EIDBI agency as inactive or terminated in the report or portal, the MCO must update its records to match.
Special Needs BasicCare
Follow fee-for-service guidelines for service authorizations if a person who receives EIDBI services is enrolled in the Special Needs BasicCare program.
Definitions
Refer to the EIDBI Benefit Policy Manual for definitions.
Legal References
Minnesota Statutes, 256B.0949 (Autism Early Intensive Intervention Benefit)
Approved Medicaid State Plan Amendment TN 17-06
Approved-Redacted Medicaid State Plan Amendment TN 18-12
Approved-Redacted Medicaid State Plan Amendment TN 19-06
Additional Resources
EIDBI advisory group webpage
DHS EIDBI benefit webpage
Brochure for EIDBI American Indian (PDF)
Brochure for EIDBI in English (PDF)
Brochure for EIDBI in Hmong (PDF)
Brochure for EIDBI in Karen (PDF)
Brochure for EIDBI in Oromo (PDF)
Brochure for EIDBI in Russian (PDF)
Brochure for EIDBI in Somali (PDF)
Brochure for EIDBI in Spanish (PDF)
Brochure for EIDBI in Vietnamese (PDF)
Minnesota Autism Resource Portal
MHCP – EIDBI Benefit Policy manual
MHCP provider directory
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