Page updated: 10/22/24

Minn. Stat. §256B.0949

A person is eligible to receive Early Intensive Developmental and Behavioral Intervention (EIDBI) services if they meet all the following criteria:

A Minnesota Health Care Programs (MHCP)-enrolled CMDE provider determines whether a person meets these eligibility criteria during the CMDE process.

ASD core characteristics include:

1. Differences in social communication and social interaction across multiple contexts, demonstrated by differences in all the following:

2. Restricted, repetitive patterns of behavior, interests or activities, demonstrated by at least two of the following:

Severity

ASD characteristics range in severity. Severity is based on social communication impairments and restricted, repetitive patterns of behavior.

Additional criteria

Additional diagnostic criteria include the following:

1. Symptoms must be present in the person’s early developmental period but might not fully be apparent:

2. Symptoms cause clinically significant interference in a person’s social, occupational or other important areas of current functioning.

3. 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, refer to the current version of the American Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM).

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

1. Is severe and chronic.

2. Results in differences in a person’s adaptive behavior and function, like that of a person with ASD.

3. Requires treatment or services, like those required for a person with ASD.

4. Results in challenges in the following symptom areas (like the symptoms of ASD):

5. May also include delays or need for a high level of support in one or more of the following related domains:

A diagnosis of ASD or a related condition must:

Using DSM versus DC:0-5

When an assessor completes a standard diagnostic assessment of a person who is age five or younger, the assessor must use the current edition of the DC: 0-5 Diagnostic Classification of Mental Health and Development Disorders of Infancy and Early Childhood, published by Zero to Three.

When an assessor completes a standard diagnostic assessment of a person who is age six or older, the assessor must use the current edition of the DSM, published by the American Psychiatric Association.

Diagnostic criteria

The diagnosing provider must use the current version of the DSM/DC:0-5 to diagnose the person.

There are important considerations to keep in mind when evaluating young children, including the following factors:

Assessment tools

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

DHS strongly 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.

Note: An IQ score and results of adaptive skills assessments are required for children to be eligible for certain types of case management and home and community-based services.

For more information, refer to Minnesota Autism Resource Portal – Screening and identification.

A CMDE is a covered EIDBI service used to provide behavior identification and assessment. Qualified providers deliver the CMDE to determine if a person has a medical need for EIDBI services. For more information about the CMDE and medical necessity determination process, refer to: