CMS-approved state plan amendment – 2017 (PDF), CMS-approved state plan amendment – 2018 update (PDF), CMS-approved state plan amendment – 2019 update (PDF), Minn. Stat. §256B.0949

Comprehensive multi-disciplinary evaluation (CMDE): An EIDBI service that covers the required comprehensive evaluation of the person. The CMDE is an assessment that must be completed to determine eligibility and medical necessity for EIDBI services, and it must be updated at least once every three years.

CMDE Medical Necessity Summary Information, DHS-7108: The form the CMDE provider uses to document and summarize the results of the person’s evaluation. The provider must submit DHS-7108 to the state medical review agent or applicable health care plan for medical necessity approval before the person can receive EIDBI services.

This page provides guidance to CMDE providers on how to complete CMDE Medical Necessity Summary Information, DHS-7108.

The CMDE provider must update a person’s CMDE at least once every three years or when clinically necessary, including when:

The CMDE provider may complete one CMDE per year without authorization. The person’s family may request a CMDE at any time.

The CMDE provider must:

For more information about how to complete the CMDE, refer to EIDBI – Individual provider trainings – CMDE and ITP Overview and the process section of EIDBI – CMDE.

At the top of DHS-7108, the CMDE provider must:

1. Select “yes” or “no” to indicate whether the CMDE includes all necessary components of a standard diagnostic assessment.

2. Enter one of the following dates:

3. Enter the person’s PMI number.

The CMDE must meet all the required components of a standard diagnostic assessment if the CMDE provider delivers the person’s initial diagnosis. In other situations, a diagnostic assessment is an optional but recommended part of the CMDE.

For more information, refer to MHCP Provider Manual – Diagnostic assessment.

In section A, the CMDE provider must document:

In section B, the CMDE provider must document:

In section C, the CMDE provider must describe:

Medical history

The CMDE provider must use the information from the medical evaluation to describe the person’s medical history. The CMDE provider must include information about:

Developmental history

The CMDE provider must document developmental history, including information about:

As part of the CMDE process, the enrolled CMDE provider (not the clinical trainee) must complete at least one observation of the person.
Note: DHS recommends completing a second observation in a second setting. The second observation may be completed by a provider who is not enrolled as an EIDBI or MHCP provider (e.g., teacher, speech therapist). If another observation is completed, the CMDE provider must document it in the CMDE.

In section D, the CMDE provider must document:

The observation must:

The observation may also include:

In section E, the CMDE provider must score the person’s level of functioning in the following developmental domains:

Communication and social interaction

Adaptive functioning/independent living

Restricted, repetitive behaviors and behavior regulation

How to score developmental domains

The CMDE provider must score each developmental domain based on the following information:

1. The person’s current level of functional impairment and support needs.

2. A comprehensive review of available clinical information informed by:

3. Objective clinical evidence documented in the person’s CMDE.

Note: When the assigned score differs substantially from standardized assessment findings or other objective clinical information, the CMDE provider must document the clinical rationale supporting the assigned score.

Developmental domain impact scores

The CMDE provider must use the following scores for each developmental domain:

Tier I or a score of 0: The person needs little to no support. Little to no support means:

Tier II or a score of 1: The person needs minimal support. Minimal support means:

Tier III or a score of 2: The person needs moderate support. Moderate support means:

Tier IV or a score of 3: The person needs substantial support. Substantial support means:

The CMDE provider uses the developmental domain scores to recommend medically necessary service intensity. For more information, refer to EIDBI – Medical necessity criteria.

As part of the CMDE process, the CMDE provider must interview at least one of the person’s caregivers/guardians.

In section F, the CMDE provider must score each of the following caregiver/guardian domains, based on the interview, observations and clinical judgement:

The CMDE provider should include any additional feedback from the caregiver/guardian or explanation of their scores.

In section G, the CMDE provider must document:

It may also be appropriate to refer families to support groups, advocates and other community-based supports (refer to Minnesota Autism Resource Portal – Supports).

If the CMDE provider does not include any referrals, they must include the reason they did not make referrals at this time.

In section H, the CMDE provider must document the following information:

Diagnostic information

In the diagnostic information section, the CMDE provider must document the person’s diagnosis and applicable diagnostic codes. For diagnostic criteria and assessment requirements, refer to EIDBI – Eligibility for services.

Levels of severity/support

In the levels of severity/support section, the CMDE provider must identify the person’s level of severity and level of support needed for social communication and restrictive, repetitive behaviors and sensory regulation.

Assessment tools

In the assessment tools section, the CMDE provider must indicate which, if any, assessments the person has had. For more information about assessment tools, refer to EIDBI – Eligibility for services.

Clinical summary and medical necessity

In the clinical summary and medical necessity section, the CMDE provider must summarize the person’s diagnostic presentation, strengths, functional needs and overall clinical picture.

Note: If the CMDE provider uses a previous diagnostic assessment from another provider or agency, they must summarize the overall diagnostic findings and confirm the diagnosis meets EIDBI eligibility requirements and the standards in Minn. Stat. §245I.10, subd. 6. If the provider chooses to complete the diagnostic assessment at the same time as the CMDE, they must ensure it meets all applicable statutory requirements.

EIDBI treatment recommendations

In the EIDBI treatment recommendations section, the CMDE provider must document:

When making treatment recommendations, the CMDE provider must consider factors that may influence assessment findings and treatment recommendations (e.g., health conditions, family circumstances, cultural or linguistic considerations, environmental factors), when applicable.

Exceptions to medical necessity criteria and service intensity framework

If the CMDE provider recommends EIDBI services that exceed or otherwise fall outside the medical necessity criteria or service intensity range as determined by the EIDBI medical necessity service intensity framework, the CMDE provider must:

1. Explain why an exception is clinically necessary, including why the expected service intensity range does not adequately address the person's assessed needs.

2. Include the objective clinical evidence, current assessment findings, developmental domain ratings, functional needs and support needs that support the requested service intensity.

3. Include supporting documentation from other qualified professionals involved in the person’s care, when applicable.

Continued medical necessity

For people who have received EIDBI services for 36 months or more, the CMDE provider must:

Note: For people receiving ongoing EIDBI services and for school-age or transition-age youth, the CMDE provider must explain:

For more information, refer to EIDBI – Medical necessity criteria.

Once DHS-7108 is complete, the following people must sign and date the CMDE signature page:

The signatures and dates must either be handwritten or use an approved electronic signature with a time and date stamp (refer to MHCP Eligibility Policy Manual – Signature).

If a CMDE clinical trainee under supervision completes the CMDE, the provider must list the CMDE supervisor as the primary CMDE provider in the mental health professional 1 field (refer to EIDBI – CMDE provider qualifications, roles and responsibilities).

The signatures serve as consent for the person to begin receiving EIDBI services.

Note: Only people who can consent to treatment and make legal decisions can sign the form. This may not include all caregivers/guardians. Providers must make sure each person who signs the form has the legal authority to do so.

Timeline

The evaluation is considered complete on the date the last person signs the CMDE signature page.

The CMDE may be completed and signed on the same day as the ITP, but the CMDE cannot be completed after the ITP.

Translated signature pages

Hmong: CMDE kos npe (Daim Ntawv Txuas Ntxiv A), DHS-7108S-HMN (PDF)
Russian: Подписи CMDE (Дополнение A), DHS-7108S-RUS (PDF)
Somali: Saxiixyada CMDE (Lifaaqa A), DHS-7108S-SOM (PDF)
Spanish: Firmas CMDE (Anexo A), DHS-7108S-SPA (PDF)
Vietnamese: Các chữ ký CMDE (Phụ lục A), DHS-7108S-VIE (PDF)
Note: The English version is included in CMDE Medical Necessity Summary Information, DHS-7108.