What is Early Intensive Developmental and Behavioral Intervention (EIDBI)?

The Early Intensive Developmental and Behavioral Intervention (EIDBI) benefit offers medically necessary services and supports to people under the age of 21 with autism spectrum disorder (ASD) or related conditions.

The purpose of the EIDBI benefit is to:

• Educate, train and support parents and families of people with ASD and related conditions
• Promote people’s independence and participation in family, school and community life
• Improve long-term outcomes and quality of life for people and their families

 

The following services are billable as EIDBI:

Comprehensive multidisciplinary evaluation (CMDE)

CMDE is an EIDBI service that covers the required comprehensive evaluation of the person. The CMDE is an assessment that must be completed when the person starts services and updated at least once every three years. The information gathered in the CMDE is used to:

• Determine the person’s eligibility and medical need for EIDBI services (refer to EIDBI – Eligibility and EIDBI – Medical necessity criteria).
• Develop the person’s individual treatment plan (ITP), including treatment type and intensity (refer to EIDBI – ITP development and progress monitoring).

 

Individual treatment plan (ITP) development and progress monitoring

The ITP development and progress monitoring is an EIDBI service that covers the development of the person’s initial ITP and ongoing monitoring of the person’s progress. The ITP is a person-centered plan of care that:

• Is created using the information gathered in the person’s comprehensive multidisciplinary evaluation (CMDE).
• Specifies the type and amount of medically necessary services the person will receive.

 

Coordinated care conference

The coordinated care conference is an EIDBI service that covers a voluntary meeting between the person, their family, EIDBI provider(s), other service professionals and/or other individuals the person/family requests to:

 

• Review the comprehensive multidisciplinary evaluation (CMDE) or individualized treatment plan (ITP).
• Integrate and coordinate services across providers and service delivery systems to develop the ITP.

 

Intervention – individual, group and higher intensity

Intervention is an EIDBI service that covers the medically necessary, intensive and individually designed direct treatment. The treatment is designed specifically to address the person’s core development skill deficits identified in their CMDE and goals/objectives specified in their ITP.

 

Intervention observation and direction

Intervention observation and direction is an EIDBI service provided by a qualified EIDBI provider that covers the clinical direction and oversight of intervention services and program modification.

 

Family or caregiver training and counseling

Family or caregiver training and counseling is an EIDBI service that covers specialized training, education and support for a person’s family/caregiver.

 

Telehealth

Telehealth is the delivery of health care services or consultations through real time, two-way interactive audio and visual communications to:

 

• Provide or support health care delivery.
• Facilitate assessment, diagnosis consultation, treatment, education and care management.

 

Travel time

Travel time is an EIDBI service that covers the time it takes for a qualified EIDBI provider to travel to and from a location other than their typical place of service to provide in-person EIDBI services

 

Services NOT covered under EIDBI

• Provider training activities that do not meet the criteria for observation and direction.
• Transportation for the person.

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).

• Exception: EIDBI may cover these activities if they are primarily for treatment and provided according to the person’s ITP.

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:

• A parent, legal guardian or another individual legally responsible for the person.
• An individual who does not meet the provider qualifications.
• An individual who has a relationship that violates ethical guidelines for dual relationship or would result in a conflict of interest, as defined by the modality or licensure.

10. Provided in the following circumstances:

• In violation of Medical Assistance (MA) policy as outlined in Minn. R. 9505.0220.
• To the general community (e.g., prevention and education programs).
• When the person is sleeping or napping.
• Without the required supervision.

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:

• Coordinated care conference.
• Family/caregiver training and counseling.
• CMDE when it is integral to a covered CMDE service.
• ITP development when it is integral to a covered ITP service.

 

Who can provide EIDBI services?

There are five (5) EIDBI provider types:

• Comprehensive multidisciplinary evaluation (CMDE) provider.
• Qualified supervising professional (QSP).
• Level I provider.
• Level II provider.
• Level III provider

 

Who is eligible to receive EIDBI services?

A person is eligible to receive EIDBI services if they meet all of the following criteria:

• Has autism spectrum disorder (ASD) or a related condition
• Has had a comprehensive multidisciplinary evaluation (CMDE) that establishes his or her medical need for EIDBI services
• Is enrolled in Medical Assistance (MA), MinnesotaCare, Minnesota Tax Equity and Fiscal Responsibility Act (TEFRA) or other qualifying health care programs
• Is under age 21

 

Steps to enroll as an EIDBI provider

To enroll as a EIDBI Agency here is a list of the process steps:

• Ensure that your employees are not on the Office of Inspector General (OIG) Exclusion List. Keep this exclusion list for your own records.
• Ensure that no person or entity identified on the Disclosure of Ownership and Control Interest of an Entity (DHS-5259) (PDF)form, or any other employees, are on the MHCP Excluded Provider Lists as an excluded group or individual provider.
• Ensure your agency initiates a background study for all direct-care staff as required.
• Complete and fax the following to MHCP Provider Enrollment at 651-431-7462:
• MHCP Organization – Provider Enrollment Application (DHS-4016A) (PDF)
• MHCP Provider Agreement (DHS-4138) (PDF)

There is requirement for a formal office space to enroll as an EIDBI agency. It is acceptable to use a home office space for this type of enrollment.
If you have specific questions about EIDBI enrollment policies, contact the Provider Call Center at 651-431-2700, option #1, or email the DHS Autism policy team at ASD.DHS@state.mn.us.

 

Rates/Reimbursement for Services

• Comprehensive Multidisciplinary Evaluation (CMDE): Behavior identification assessment / 97151 / 15 min / $43.58
• Individual Treatment Plan (ITP) Development and Monitoring / H0032 / per encounter / $82.44
• Coordinated Care Conference: Medical Team Conference / T1024 / per encounter / $97.87
• Intervention–Individual: Adaptive behavior treatment by protocol / 97153 / 15 min / $17.54
• Intervention–Group: Group adaptive behavior treatment by protocol / 97154 / 15 min / $5.84
• Intervention–Higher intensity: Adaptive behavior treatment with modifications in protocol administered by two or more providers / 0373T / 15 min / $21.04
• Intervention–Individual: Observation and Direction: Adaptive behavior treatment with protocol modification / 97155 / 15 min / $17.54
• Family or Caregiver Training and Counseling –Individual: Family adaptive behavior treatment guidance / 97156 / 15 min / $17.54
• Family or Caregiver Training and Counseling –Group: Multiple family group adaptive behavior treatment guidance / 97157 / 15 min / $5.84
• Travel Time / H0046 / 1 min / $0.45