Legal authority

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

Overview

The Early Intensive Developmental and Behavioral Intervention (EIDBI) benefit is a Minnesota Health Care Program (MHCP) that offers medically necessary treatment to people who:

A person does not have to exhaust other service options (e.g., occupational therapy, speech and language or special education services) before accessing EIDBI services.

If a person qualifies for other Medicaid-funded services (e.g., personal care assistance [PCA], home and community-based services [HCBS] waivers, etc.), they may also be eligible to receive EIDBI services. For information, see EIDBI – Services – Coordination with other services.

Eligibility and referral

A CMDE provider (who may or may not be affiliated with an EIDBI agency) must complete an initial CMDE to determine eligibility and medical necessity for a person with ASD or a related condition. If the CMDE provider is not affiliated with an EIDBI agency, the case manager and CMDE provider should work together to refer the person to an EIDBI agency for services.

A CMDE provider must update a person’s CMDE at least once every three years, unless clinically needed or requested by a parent/guardian. For more information, see EIDBI – CMDE.

A CMDE may incorporate the results from a previous diagnostic assessment or qualify as a diagnostic assessment if one has not been completed. For information about diagnostic assessments, see MHCP Provider Manual – Diagnostic assessment.

A related condition is a condition that is chronic and present since the early developmental years. The condition may also present deficits in social interaction, communication, restrictive or repetitive behaviors or the need for support to manage:

There are important considerations to keep in mind when evaluating young children, including the following factors that increase the likelihood of ASD:

For more information, including complete definitions of ASD and related conditions, see EIDBI – Eligibility for EIDBI services.

Resources

The MN Autism Interagency team created a wide array of documents translated into multiple languages to support families and professionals. To learn more about these resources, visit MN Autism Resource Portal – Pathway to services and supports.

To learn about how to find an EIDBI provider or make a referral for EIDBI services, use the pathway to EIDBI services for families tool:

To explore additional services and supports, use the autism services and supports navigation tool:

Covered services

Under the EIDBI benefit, a person with ASD or a related condition may receive a range of individualized services. These services target the functional skills and core symptoms of ASD and related conditions to promote the person’s optimal independence and participation in family, school and community life.

Services may include, but are not limited to:

Services can occur in the person’s home or other community living setting, such as a school, office, center or clinic. Some EIDBI providers may offer services via telehealth to reach people in remote locations or who are unable to access in-person services.

The person may still be able to access EIDBI services if they receive PCA, HCBS, child welfare services, case management or other services.

For more information about services, including coordination of services under the EIDBI benefit, see EIDBI – Services.

Providers

EIDBI services are delivered by providers who are enrolled with MHCP and meet all qualifications.

Providers are independent entities. They determine the modality they use. They also determine the regions of Minnesota they serve, the ages of people they support and the setting of service delivery (e.g., home, center-based).

EIDBI – Overview of EIDBI providers includes information about:

Families can find EIDBI providers in their area using MHCP provider search or EIDBI provider map, which includes a tab for providers across Minnesota and a tab for providers located in the metro area.

Trainings

ASD Strategies in Action is an online, video-based learning series for families, lead agencies and providers that covers the characteristics of ASD and evidenced-based strategies to support people with ASD in homes, schools and community settings.

EIDBI 101: Overview of the Benefit is an online training about the various requirements of EIDBI services, including eligibility, access, covered and non-covered services and more. There is a version for EIDBI providers and a version for families and lead agencies.

For additional trainings, visit MN Autism Resource Portal – Trainings and events and EIDBI – Overview of training for EIDBI providers.