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

Every Early Intensive Developmental and Behavioral Intervention (EIDBI) service must address the person’s medically necessary treatment goals and be targeted to develop, enhance or maintain the person’s developmental skills to improve their:

Every EIDBI intervention service must:

The person must receive a CMDE to determine if they have a medical need for EIDBI services. They must have a completed CMDE Medical Necessity Summary Information, DHS-7108 (PDF) signed and dated by the following people:

Once the person is determined eligible for EIDBI services, the provider agency must develop an individualized treatment plan (ITP). Before the person can start or continue receiving services, they must have a completed ITP and Progress Monitoring, DHS-7109 signed and dated by the following people:

The signatures on DHS-7108 and DHS-7109 serve as consent for the person to begin or continue receiving EIDBI services. The signatures must meet the requirements on EIDBI – How to complete CMDE Medical Necessity Summary Information, DHS-7108 and EIDBI – How to complete ITP and Progress Monitoring, DHS-7109.

Note: Only people who can consent to treatment and make legal decisions can sign these forms. This may not include all caregivers. Providers must ensure the person signing the forms has the legal authority to do so.

Person-centered planning ensures EIDBI services:

The EIDBI benefit covers the following services:

Refer to the service-specific pages for more information.

Telehealth services

A person may receive some EIDBI services via telemedicine. For more information, refer to EIDBI – Telehealth services.

Simultaneous services

Multiple providers may deliver and bill for the following services at the same time:

Multiple providers may deliver a combination of EIDBI services at the same time, such as one provider delivering individual intervention and another provider delivering observation and direction.

Providers are responsible to ensure codes can be billed simultaneously, including any non-EIDBI service codes, by calling the MHCP Provider Call Center at 800-366-5411 or using DHS – Minnesota National Correct Coding Initiative.

The person may receive EIDBI services in the following settings:

For more information, including setting definitions and documentation requirements, refer to EIDBI – Settings for EIDBI services.

The person’s EIDBI services must coordinate with all other services to ensure they receive the most appropriate and effective combination to meet their needs.

Educational/academic services

EIDBI services are not intended to replace educational or academic services. EIDBI provider agencies and individual EIDBI providers must:

This does not prevent the person from receiving EIDBI services during school hours or on school grounds. However, if the person does receive EIDBI services during school hours or on school grounds, their ITP must document why, including specific goals and objectives. For more information, refer to:

Other Medicaid-funded services

The person may receive EIDBI services in conjunction with other Medicaid-funded services, including, but not limited to:

The following EIDBI services are allowable in a PRTF:

If the person or provider is requesting EIDBI and other Medicaid-funded services to be provided at the same time, the request will be reviewed by the DHS medical review agent and DHS policy areas to determine if medical necessity has been established for those services to happen concurrently. Documentation must support the medical necessity criteria for concurrent or simultaneous services. The medical review agent may request additional documentation to make a determination, if necessary.

EIDBI and HCBS service coordination

The person can receive EIDBI and HCBS services at the same time. This includes, but is not limited to:

The EIDBI provider and HCBS provider both are responsible to ensure they provide the services within the service scope, including requirements for eligibility, covered services, limitations, provider standards and billing. Both providers must ensure they are not duplicating services. For more information about these requirements, refer to the applicable pages in this manual and the Community-Based Services Manual (CBSM).

The EIDBI benefit does not cover:

The EIDBI benefit does not cover services that are:

1. Conducted via mail or email.

2. For the purpose of reporting, charting or record-keeping, except when it is integral to a covered CMDE or ITP service or a health service record.

3. Not documented in the person’s health service record or ITP in the manner outlined in this manual or Minn. R. 9505.2175.

4. Primarily for custodial, day care or respite purposes.

5. Primarily recreational and not supervised by a medical professional (e.g., sports activities, craft activities, meal/snack time, trips to community activities, tours).

6. The responsibility of a residential or program license holder (e.g., foster care provider) according to a service agreement or administrative licensing rules.

7. Not approved by DHS’ medical review agent, except for services that do not require authorization.

8. Including or replacing academic goals that are otherwise included in the person’s Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP), as required under the Individuals with Disabilities Education Improvement Act of 2004 (IDEA).

9. Provided by:

10. Provided in the following circumstances:

11. Not provided (e.g., appointment no-shows).

12. Not provided directly to a person who is present either physically or via interactive video, with the exception of the following services that do not require the person to be present:

Families have the right to transfer or change EIDBI provider agencies for any reason.

New agency’s responsibilities

The new agency is responsible to work with the family to gather discharge information from the previous agency. When a family chooses to transfer or a provider recommends a transfer, the new agency should ask the family to sign a release of information form to gather previous records. The new agency can use either General Consent/Authorization for Release of Information, DHS-3549 (PDF) or an agency-developed release form.

The new agency should review the records and determine if the person’s previous CMDE and ITP are still valid. If the CMDE and ITP are still valid, the new agency may use them for authorization.

The new agency should complete a CMDE and ITP, as instructed on EIDBI – How to complete CMDE Medical Necessity Summary Information, DHS-7108 and EIDBI – How to complete ITP and Progress Monitoring, DHS-7109, in any of the following situations:

If the person has already used the set number of CMDE and ITP units, the new agency may submit EIDBI Authorization Request, DHS-3806 to request authorization of additional services beyond the service limit threshold.

Refer to MHCP Provider Manual – EIDBI benefit for service authorization instructions, billing limits and additional information. Refer to MHCP Provider Directory for EIDBI agency contact information.

At the time of the authorization request, the new agency must ensure the previous agency has either:

If the new agency does not have the above information, DHS’ medical review agent will reject the request. EIDBI services can only be approved after the discharge date if DHS’ medical review agent determines the transition is medically necessary.

Previous agency’s responsibilities

The previous agency should provide the new agency with all of the following information:

The previous agency should notify DHS’ medical review agent and request to end the person’s service authorization, effective on the date of discharge. This will prevent service agreement overlap and denial of authorization requests.

Providers must follow EIDBI policy, as described throughout the EIDBI Policy Manual, and consult with the person’s caregiver/guardian about the transition plan.

Completing DHS-7109A

When the person transfers agencies, the QSP at the previous agency should download and complete EIDBI transition and/or discharge summary, DHS-7109A electronically. For more information, including instructions to complete the form, refer to the DHS-7109A section on EIDBI – How to complete ITP and Progress Monitoring, DHS-7109.

The EIDBI provider agency may terminate the person’s EIDBI services if one of the medical necessity termination criteria is met.

The provider must send notice of termination to the person or legal representative. The transition period begins when the person or the legal representative receives notice of termination and ends on the last date of EIDBI services. DHS allows up to 30 days of continued service during the transition period. Services during the transition period must be consistent with what is documented in the ITP (refer to EIDBI – How to complete ITP and Progress Monitoring, DHS-7109).

Transition plan

The transition plan, documented in the person’s ITP, must include:

Completing DHS-7109A

When services are terminated, the QSP should download and complete EIDBI transition and/or discharge summary, DHS-7109A electronically. For more information, including instructions to complete the form, refer to the DHS-7109A section on EIDBI – How to complete ITP and Progress Monitoring, DHS-7109.

Note: DHS-7109A is separate from the transition plan documented in the person’s ITP.