CMS-approved state plan amendment – 2017 (PDF), CMS-approved state plan amendment – 2018 update (PDF), CMS-approved state plan amendment – 2019 update (PDF), CMS-approved state plan amendment – 2022 update (PDF), Minn. Stat. §256B.0949, Minn. Stat §245A.142, Minn. Stat. §144.651, Minn. R. 9544.0060, Minn. R. 9505.2175, Minn. R. 9505.2197, Minn. Stat. §245C, Minn. Stat. §245A.02, subd. 5(a), Minn. Stat. §256B.04, subd. 21(g)

Agency: A legal entity enrolled with Minnesota Health Care Programs (MHCP) as a Medical Assistance (MA) provider, according to Minn. R. 9505.0195, to provide EIDBI services. This includes an individual licensed professional who practices independently and acts as an agency. The agency is legally responsible for making sure its employees provide EIDBI services according to all applicable laws.

Employee: A person who is employed temporarily, part time or full time by the agency that submits claims or billing for the work, services, supervision or treatment performed by the person. This does not include:

Legal representative: The parent of a child younger than age 18, a court-appointed guardian or other representative with legal authority to make decisions about services for a person.

Other representative with legal authority to make decisions: A health care agent or an attorney-in-fact authorized through a health care directive or power of attorney.

This page explains:

All people who receive EIDBI services and their legal representatives have rights and responsibilities, as listed on EIDBI Your Rights and Responsibilities, DHS-7645A (PDF).

EIDBI provider agencies and their staff also have responsibilities to people to who receive services, as listed on EIDBI Provider Agency Responsibilities, DHS-7645B (PDF).

The person and their legal representative have the right to:

1. Be protected as defined under the health care bill of rights (Minn. Stat. §144.651).

2. Choose an advocate to be present in all aspects of the person’s services at the request of the legal representative.

3. Be informed of the:

4. Be free from seclusion and restraint, except for emergency use of manual restraint. For more information, refer to emergency use of manual restraint in Guidelines for Positive Supports in DHS-Licensed Settings, DHS-6810C (PDF).

5. Be supervised by a responsible adult at all times.

6. Be notified by the provider agency within 24 hours if an incident occurs or the person is injured while receiving services. The notification should include what happened and how the provider agency staff responded to the incident.

7. Request a voluntary coordinated care conference (refer to EIDBI – Coordinated care conference).

8. Request a comprehensive multi-disciplinary evaluation (CMDE) provider of the person’s or legal representative’s choice.

9. Be free from all prohibitions, punishment, restraint, etc., as defined in the positive supports rule (refer to Minn. R. 9544.0060).

10. File an appeal. For provider-related information about the appeals process, refer to CBSM – Appeals. For more information, refer to DHS – Appeals and DHS – Appeals frequently asked questions.

For a complete list of the rights and responsibilities of people who receive services, refer to EIDBI Your Rights and Responsibilities, DHS-7645A (PDF).

Enrollment responsibilities

An agency delivering EIDBI services must:

1. Enroll as an MHCP provider and meet all applicable standards and requirements. For more information, refer to MHCP Provider Manual – EIDBI provider enrollment criteria and forms.

2. Demonstrate that, while enrolled or pursuing enrollment as an MHCP provider, the agency did not have a lead agency contract or provider agreement discontinued because of a fraud conviction.

Compliance responsibilities

An agency delivering EIDBI services must:

1. Demonstrate compliance with federal and state laws for EIDBI service delivery and billing that prohibit providers from:

2. Comply with all background study requirements, including those in Minn. Stat. §245C, before they deliver and bill for any service. For more information, refer to DHS – EIDBI background studies.
Note: Rendering providers who do not have background study documentation on file are subject to monetary recovery of claims billed.

3. Comply with any data requests.

4. Identify the agency’s controlling individuals, as defined under Minn. Stat. §245A.02, subd. 5(a).

5. Disclose the use of billing agencies and other consultants who do not provide EIDBI services.

6. Provide DHS with copies of any contracts with consultants or independent contractors who do not provide EIDBI services, including hours contracted and responsibilities.

7. Designate a person as the agency’s compliance officer to perform the duties described in Minn. Stat. §256B.04, subd. 21(g).

Operational responsibilities

An agency delivering EIDBI services must:

1. Verify and maintain health service records for every person it serves, as described in Minn. R. 9505.2175 and Minn. R. 9505.2197. For more information, refer to EIDBI – Health service records.

2. Have established business practices, including:

3. Document personnel records, including staff qualifications and required training.

4. Maintain a licensed agency with a physical address in Minnesota and provide EIDBI services to eligible Minnesota recipients in Minnesota. For more information, refer to DHS – EIDBI licensing.

5. Provide training for all agency staff on the requirements and responsibilities listed in DHS – Mandated reporter resources and the Vulnerable Adult Protection Act, including:

6. Have a written policy to resolve issues collaboratively, when possible, and share the policy with the person and their legal representative.
Note: The policy must include a timeline for when the agency will notify the person and their legal representative about issues that arise during service delivery.

7. Promptly notify the person’s legal representative if the person is injured or if the agency completes an incident report for any reason during service delivery. The agency also must:

8. Ensure a qualified supervising professional (QSP):

Communication responsibilities

An agency delivering EIDBI services must:

1. Provide the person or their legal representative with a description of the treatment modality the person will receive before services begin. This includes the certification levels and training of staff who will provide the treatment (refer to EIDBI – Treatment modalities).

2. Determine how to adapt the evaluation, treatment recommendations and ITP to align with the person’s and legal representative’s culture, values and language preferences.

3. Have a Limited English Proficiency (LEP) plan that complies with Title VI of the Civil Rights Act of 1964.

4. Offer communication and language assistance that complies with the National Standards for Culturally and Linguistically Appropriate Services (CLAS), as published by the U.S. Department of Health and Human Services.

5. Review the rights and responsibilities with the person and their legal representative before services begin and at least every year thereafter.

For a complete list of provider agency responsibilities, refer to EIDBI Provider Agency Responsibilities, DHS-7645B (PDF).

When the EIDBI provider agency delivers the person’s initial ITP and annually thereafter, the EIDBI provider agency must:

EIDBI Compliance and Program Integrity Guide, DHS-8632 (PDF) is a comprehensive resource for EIDBI providers. By following the practices in the guide, providers can:

To maintain compliance and deliver high-quality services, providers must:

People who receive EIDBI services must be free from seclusion or the use of manual restraints, except for the use of emergency manual restraints. For more information, refer to: