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

Intervention (also known as adaptive behavior treatment): An EIDBI service that covers the medically necessary, intensive and individually designed direct treatment. The treatment specifically addresses the person’s core developmental skill needs identified in their comprehensive multi-disciplinary evaluation (CMDE) and goals/objectives specified in their individual treatment plan (ITP).

Individual intervention session: A defined time period when a qualified EIDBI provider delivers intervention to one person.

Group intervention session: A defined time period when a qualified EIDBI provider delivers intervention to at least two, but no more than eight, people who receive EIDBI services.

Higher intensity intervention session: A defined time period when two or more qualified EIDBI providers deliver intervention to one person under the direction of an on-site (e.g., in person or via telehealth) and available qualified supervising professional (QSP) or level I provider.

Session: A defined time period when a qualified EIDBI provider delivers an EIDBI service to a person. Each provider agency may further define a session, but all EIDBI intervention sessions must:

The following enrolled Minnesota Health Care Programs (MHCP) EIDBI providers can deliver and bill for individual and group intervention sessions:

The person should receive intervention according to one of the DHS-recognized treatment modalities. For more information, refer to EIDBI – Treatment modalities and EIDBI – Treatment modalities – Certified providers.

Group session

In a group intervention session, each participating person must have an approved EIDBI service agreement and rationale for group intervention services in their ITP.

At least two, but not more than eight, people who receive EIDBI services must be present at one time to bill for group intervention services.

Higher intensity session

In a higher intensity intervention session, the person must have an approved EIDBI service agreement and rationale for higher intensity intervention services in their ITP. A QSP or level I provider must be immediately available for support during this service, which includes telehealth availability when clinically appropriate. If the QSP or level I provider participates in the session, they should use billing code 97155 for the time.

Higher intensity sessions include two or more providers engaging with the person during specific environmental circumstances where severe, destructive behaviors (e.g., self-injurious behavior, damage to property or aggression) have been observed in the past. The providers must record and analyze data and make appropriate adjustments.

This type of intervention must occur in a controlled and safe customized environment and include protocol modifications to address the severe, destructive behaviors. Protocol modifications may include, but are not limited to:

1. Adjustments to specific procedure components or treatment objectives during the session, including:

2. Observation and assessment to determine if the program components either:

3. Active direction or feedback to an EIDBI provider while that provider delivers a service (e.g., intervention). Direction or feedback may include:

4. Program implementation by a qualified EIDBI provider with the person to either:

Provider ratios

In an individual intervention session, one provider delivers intervention services to one person.

In a group intervention session, one provider delivers services to two to eight people who receive EIDBI services.

In a higher intensity intervention session, two or more providers deliver services to one person.

Session parameters

All intervention sessions start when the provider begins to deliver intervention to the person or people.

All intervention sessions end when the provider stops delivering intervention to the person or people.

A session is done when any of the following situations occur:

The session must end on the same day it began.

If the provider recommends an increase in EIDBI service intensity, they may request a change in an ITP progress monitoring update.

The change in EIDBI service intensity must meet medical necessity criteria. For more information, refer to EIDBI – Medical necessity criteria.

The provider must document intervention services in the person’s case notes. For more information, refer to EIDBI – Health service records.

For authorization and billing information, including provider and service limits, refer to:

All EIDBI providers are responsible to deliver intervention services according to the specifications in the person’s ITP.

The QSP must ensure all providers accurately implement and bill for all intervention services.

All level I, II and III providers must receive clinical supervision from a QSP for intervention services they provide.