Source: https://www.revisor.mn.gov/statutes/cite/256B.0949
Timestamp: 2019-06-21 00:19:33
Document Index: 773091955

Matched Legal Cases: ['art 1', 'art 27', 'art 27', 'art 27', 'art 1', 'art 27', 'art 7', 'art 7', 'art 1', 'art 27', 'art 10', 'art 1']

Section 256B.0949
256B.0948 256B.095
Early intensive developmental and behavioral intervention advisory council
2018 Subd. 13 Amended 2018 c 182 art 1 s 51
2017 256B.0949 Amended 2017 c 19 s 1
2014 Subd. 4 Amended 2014 c 312 art 27 s 52
2014 Subd. 5 Amended 2014 c 312 art 27 s 53
2014 Subd. 11 Amended 2014 c 312 art 27 s 54
2014 Subd. 11 Amended 2014 c 275 art 1 s 63
2014 Subd. 12 New 2014 c 312 art 27 s 55
2013 256B.0949 New 2013 c 108 art 7 s 14
256B.0949 EARLY INTENSIVE DEVELOPMENTAL AND BEHAVIORAL INTERVENTION BENEFIT.
This section authorizes the early intensive developmental and behavioral intervention (EIDBI) benefit to provide early intensive intervention to a person with an autism spectrum disorder or a related condition. This benefit must provide coverage for a comprehensive, multidisciplinary evaluation, ongoing progress monitoring, and medically necessary early intensive treatment of autism spectrum disorder or a related condition. Nothing in this section shall preclude coverage for other medical assistance benefits based on a person's diagnosis of an autism spectrum disorder or a related condition, including, but not limited to, coverage under section 256B.0943 of children's therapeutic services and supports.
(a) The terms used in this section have the meanings given in this subdivision.
(d) "Person" means a person under 21 years of age.
(f) "Commissioner" means the commissioner of human services, unless otherwise specified.
(i) "Early intensive developmental and behavioral intervention benefit" or "EIDBI benefit" means a variety of individualized, intensive treatment modalities approved by the commissioner that are based in behavioral and developmental science consistent with best practices on effectiveness.
(j) "Generalizable goals" means results or gains that are observed during a variety of activities over time with different people, such as providers, family members, other adults, and people, and in different environments including, but not limited to, clinics, homes, schools, and the community.
(n) "Mental health professional" has the meaning given in section 245.4871, subdivision 27, clauses (1) to (6).
Subd. 3.EIDBI eligibility.
An EIDBI service is available to a person enrolled in medical assistance who:
(1) has a diagnosis of ASD or a related condition that meets the criteria of subdivision 4; and
(2) meets the criteria for medical necessity for the EIDBI benefit.
Subd. 3a.Culturally and linguistically appropriate requirement.
Subd. 4.Diagnosis.
(1) be based upon current DSM criteria including direct observations of the person and information from the person's legal representative or primary caregivers;
(b) Additional assessment information may be considered to complete a diagnostic assessment including specialized tests administered through special education evaluations and licensed school personnel, and from professionals licensed in the fields of medicine, speech and language, psychology, occupational therapy, and physical therapy. A diagnostic assessment may include treatment recommendations.
Subd. 5.Comprehensive multidisciplinary evaluation.
(a) A CMDE must be completed to determine medical necessity of EIDBI services. For the commissioner to authorize EIDBI services, the CMDE provider must submit the CMDE to the commissioner and the person or the person's legal representative as determined by the commissioner. Information and assessments must be performed, reviewed, and relied upon for the eligibility determination, treatment and services recommendations, and treatment plan development for the person.
(1) include an assessment of the person's developmental skills, functional behavior, needs, and capacities based on direct observation of the person which must be administered by a CMDE provider, include medical or assessment information from the person's physician or advanced practice registered nurse, and may also include input from family members, school personnel, child care providers, or other caregivers, as well as any medical or assessment information from other licensed professionals such as rehabilitation or habilitation therapists, licensed school personnel, or mental health professionals;
Subd. 5a.Comprehensive multidisciplinary evaluation provider qualification.
Subd. 6.Individual treatment plan.
(b) Each person's ITP must be:
(2) based on the diagnosis and CMDE information specified in subdivisions 4 and 5.
(c) The ITP must specify:
(d) Implementation of the ITP must be supervised by a QSP.
(e) The ITP must be submitted to the commissioner and the person or the person's legal representative for approval in a manner determined by the commissioner for this purpose.
(f) A service included in the ITP must meet all applicable requirements for medical necessity and coverage.
Subd. 7.Individual treatment plan progress monitoring.
(a) An ITP progress monitoring must be submitted after each six months of treatment, or more frequently as determined by the CMDE provider or QSP, to determine if progress is being made toward targeted functional and generalizable goals specified in the ITP. Based on the results of ITP progress monitoring, the ITP must be adjusted as needed and must document that the EIDBI service continues to be medically necessary for the person or the person is referred to other services.
(b) The ITP progress monitoring must include:
(1) input from the person's legal representative or the person's primary caregiver;
(2) an observation of the person that is performed by the QSP, level I treatment provider, or level II treatment provider and may include input from licensed special education staff or other licensed health care provider;
(5) any treatment plan modification and the rationale for any change made, including treatment modality, intensity, frequency, and duration; and
(6) recommendations for continued treatment.
(c) The ITP progress monitoring must be submitted to the commissioner and the person or the person's legal representative in a manner determined by the commissioner for the reauthorization of EIDBI services.
(d) A person who continues to make reasonable progress toward treatment goals as specified in the ITP is eligible to continue receiving EIDBI services.
(e) A person's treatment shall continue during the ITP progress monitoring using the process determined under this subdivision. Treatment may continue during an appeal pursuant to section 256.045.
Subd. 8.Refining the benefit with stakeholders.
The commissioner must refine the details of the benefit in consultation with stakeholders and consider recommendations from the Department of Human Services Early Intensive Developmental and Behavioral Intervention Advisory Council, the early intensive developmental and behavioral intervention learning collaborative, and the Departments of Health, Education, Employment and Economic Development, and Human Services. The details must include, but are not limited to, the following components:
(1) a definition of the qualifications, standards, and roles of the treatment team, including recommendations after stakeholder consultation on whether board-certified behavior analysts and other professionals certified in other treatment approaches recognized by the department or trained in ASD or a related condition and child development should be added as professionals qualified to provide EIDBI clinical supervision or other functions under medical assistance;
(2) refinement of uniform parameters for CMDE and ongoing ITP progress monitoring standards;
(3) the design of an effective and consistent process for assessing the person's and the person's legal representative's and the person's caregiver's preferences and options to participate in the person's early intervention treatment and efficacy of methods to involve and educate the person's legal representative and caregiver in the treatment of the person;
(4) formulation of a collaborative process in which professionals have opportunities to collectively inform provider standards and qualifications; standards for CMDE; medical necessity determination; efficacy of treatment apparatus, including modality, intensity, frequency, and duration; and ITP progress monitoring processes to support quality improvement of EIDBI services;
(6) evaluation, on an ongoing basis, of EIDBI services outcomes and efficacy of treatment modalities provided to people under this benefit; and
(7) as provided under subdivision 17, determination of the availability of qualified EIDBI providers with necessary expertise and training in ASD or a related condition throughout the state to assess whether there are sufficient professionals to provide timely access and prevent delay in the CMDE and treatment of a person with ASD or a related condition.
Subd. 9.Revision of treatment options.
(7) have goals and objectives that are measurable, achievable, and regularly evaluated and adjusted to ensure that adequate progress is being made;
(b) Before revisions in department recognized treatment modalities become effective, the commissioner must provide public notice of the changes, the reasons for the change, and a 30-day public comment period to those who request notice through an electronic list accessible to the public on the department's website.
Subd. 10.Coordination between agencies and other benefits.
Subd. 11.Federal approval of the EIDBI benefit.
(b) The commissioner may use the federal authority for a Medicaid state plan amendment under Early and Periodic Screening Diagnosis and Treatment (EPSDT), United States Code, title 42, section 1396D(R)(5), or other Medicaid provision for any aspect or type of treatment covered in this section if new federal guidance is helpful in achieving one or more of the purposes of this section in a cost-effective manner. Notwithstanding subdivisions 2 and 3, any treatment services submitted for federal approval under EPSDT shall include appropriate medical criteria to qualify for the service and shall cover children through 20 years of age.
Subd. 12.EIDBI benefit; training provided.
After approval of the EIDBI benefit under this section by the Centers for Medicare and Medicaid Services, the commissioner shall provide statewide training on the benefit for culturally and linguistically diverse communities. Training for EIDBI providers on culturally appropriate practices must be online, accessible, and available in multiple languages. The training for families, lead agencies, advocates, and other interested parties must provide information about the EIDBI benefit and how to access it.
Subd. 13.Covered services.
(a) The services described in paragraphs (b) to (i) are eligible for reimbursement by medical assistance under this section. Services must be provided by a qualified EIDBI provider and supervised by a QSP. An EIDBI service must address the person's medically necessary treatment goals and must be targeted to develop, enhance, or maintain the individual developmental skills of a person with ASD or a related condition to improve functional communication, social or interpersonal interaction, behavioral challenges and self-regulation, cognition, learning and play, self-care, and safety.
Subd. 14.Person's rights.
Subd. 15.EIDBI provider qualifications.
(iii) a board-certified behavior analyst; or
(ii) has certification as a board-certified assistant behavior analyst from the Behavior Analyst Certification Board;
(1) a high school diploma or commissioner of education-selected high school equivalency certification;
Subd. 16.Agency duties.
(2) documentation in the person's file the date that the person or the person's legal representative received a copy and explanation of the person's or person's legal representative's rights and the agency's responsibilities; and
Subd. 17.Provider shortage; authority for exceptions.
2013 c 108 art 7 s 14; 2014 c 275 art 1 s 63,140; 2014 c 312 art 27 s 52-55; 2017 c 19 s 1; 1Sp2017 c 5 art 10 s 7; 2018 c 182 art 1 s 51