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SF 562

1st Engrossment - 90th Legislature (2017 - 2018) Posted on 05/05/2017 08:54am

KEY: stricken = removed, old language.
underscored = added, new language.
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A bill for an act
relating to human services; modifying certain provisions governing autism early
intensive intervention benefit; amending Minnesota Statutes 2016, section
256B.0949.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2016, section 256B.0949, is amended to read:


256B.0949 deleted text beginAUTISMdeleted text end EARLY INTENSIVEnew text begin DEVELOPMENTAL AND
BEHAVIORAL
new text end INTERVENTION BENEFIT.

Subdivision 1.

Purpose.

This section deleted text begincreates a new benefitdeleted text endnew text begin authorizes the early intensive
developmental and behavioral intervention (EIDBI) benefit
new text end to provide early intensive
intervention to a deleted text beginchilddeleted text endnew text begin personnew text end with an autism spectrum disorder deleted text begindiagnosisdeleted text endnew text begin or a related
condition
new text end. This benefit must provide coverage for deleted text begindiagnosisdeleted text endnew text begin a comprehensivenew text end,
multidisciplinary deleted text beginassessmentdeleted text endnew text begin evaluationnew text end, ongoing progress deleted text beginevaluationdeleted text end new text beginmonitoringnew text end, and
medically necessarynew text begin early intensivenew text end treatment of autism spectrum disordernew text begin 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
new text end.

Subd. 2.

Definitions.

(a) deleted text beginFor the purposes of this section,deleted text end The terms deleted text begindefineddeleted text endnew text begin usednew text end in this
deleted text begin subdivisiondeleted text endnew text begin sectionnew text end have the meanings givennew text begin in this subdivisionnew text end.

deleted text begin (b) "Autism spectrum disorder diagnosis" is defined by diagnostic code 299 in the current
version of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
deleted text end

new text begin (b) "Agency" means the legal entity that is enrolled with Minnesota health care programs
as a medical assistance provider according to Minnesota Rules, part 9505.0195, to provide
EIDBI services and that has the legal responsibility to ensure that its employees or contractors
carry out the responsibilities defined in this section. Agency includes a licensed individual
professional who practices independently and acts as an agency.
new text end

new text begin (c) "Autism spectrum disorder or a related condition" or "ASD or a related condition"
means either autism spectrum disorder (ASD) as defined in the current version of the
Diagnostic and Statistical Manual of Mental Disorders (DSM) or a condition that is found
to be closely related to ASD, as identified under the current version of the DSM, and meets
all of the following criteria:
new text end

new text begin (1) is severe and chronic;
new text end

new text begin (2) results in impairment of adaptive behavior and function similar to that of a person
with ASD;
new text end

new text begin (3) requires treatment or services similar to those required for a person with ASD; and
new text end

new text begin (4) results in substantial functional limitations in three core developmental deficits of
ASD: social interaction; nonverbal or social communication; and restrictive, repetitive
behaviors or hyperreactivity or hyporeactivity to sensory input; and may include deficits or
a high level of support in one or more of the following domains:
new text end

new text begin (i) self-regulation;
new text end

new text begin (ii) self-care;
new text end

new text begin (iii) behavioral challenges;
new text end

new text begin (iv) expressive communication;
new text end

new text begin (v) receptive communication;
new text end

new text begin (vi) cognitive functioning; or
new text end

new text begin (vii) safety.
new text end

deleted text begin (c)deleted text endnew text begin (d)new text end "deleted text beginChilddeleted text endnew text begin Personnew text end" means a person under deleted text beginthe age of 18deleted text endnew text begin 21 years of agenew text end.

new text begin (e) "Clinical supervision" means the overall responsibility for the control and direction
of EIDBI service delivery, including individual treatment planning, staff supervision,
individual treatment plan progress monitoring, and treatment review for each person. Clinical
supervision is provided by a qualified supervising professional (QSP) who takes full
professional responsibility for the service provided by each supervisee.
new text end

deleted text begin (d)deleted text endnew text begin (f)new text end "Commissioner" means the commissioner of human services, unless otherwise
specified.

new text begin (g) "Comprehensive multidisciplinary evaluation" or "CMDE" means a comprehensive
evaluation of a person to determine medical necessity for EIDBI services based on the
requirements in subdivision 5.
new text end

new text begin (h) "Department" means the Department of Human Services, unless otherwise specified.
new text end

deleted text begin (e)deleted text endnew text begin (i)new text end "Early intensivenew text begin developmental and behavioralnew text end intervention benefit"new text begin or "EIDBI
benefit"
new text end means deleted text beginautism treatment optionsdeleted text endnew text begin a variety of individualized, intensive treatment
modalities approved by the commissioner that are
new text end based in behavioral and developmental
sciencedeleted text begin, which may include modalities such as applied behavior analysis, developmental
treatment approaches, and naturalistic and parent training models
deleted text endnew text begin consistent with best
practices on effectiveness
new text end.

deleted text begin (f)deleted text endnew text begin (j)new text end "Generalizable goals" means results or gains that are observed during a variety of
activitiesnew text begin over timenew text end with different people, such as providers, family members, other adults,
and deleted text beginchildrendeleted text endnew text begin peoplenew text end, and in different environments including, but not limited to, clinics,
homes, schools, and the community.

new text begin (k) "Incident" means when any of the following occur:
new text end

new text begin (1) an illness, accident, or injury that requires first aid treatment;
new text end

new text begin (2) a bump or blow to the head; or
new text end

new text begin (3) an unusual or unexpected event that jeopardizes the safety of a person or staff,
including a person leaving the agency unattended.
new text end

new text begin (l) "Individual treatment plan" or "ITP" means the person-centered, individualized written
plan of care that integrates and coordinates person and family information from the CMDE
for a person who meets medical necessity for the EIDBI benefit. An individual treatment
plan must meet the standards in subdivision 6.
new text end

new text begin (m) "Legal representative" means the parent of a child who is under 18 years of age, a
court-appointed guardian, or other representative with legal authority to make decisions
about service for a person. For the purpose of this subdivision, "other representative with
legal authority to make decisions" includes a health care agent or an attorney-in-fact
authorized through a health care directive or power of attorney.
new text end

deleted text begin (g)deleted text endnew text begin (n)new text end "Mental health professional" has the meaning given in section 245.4871,
subdivision 27, clauses (1) to (6).

new text begin (o) "Person-centered" means a service that both responds to the identified needs, interests,
values, preferences, and desired outcomes of the person or the person's legal representative
and respects the person's history, dignity, and cultural background and allows inclusion and
participation in the person's community.
new text end

new text begin (p) "Qualified EIDBI provider" means a person who is a QSP or a level I, level II, or
level III treatment provider.
new text end

Subd. 3.

deleted text beginInitialdeleted text endnew text begin EIDBInew text end eligibility.

deleted text beginThis benefitdeleted text endnew text begin An EIDBI servicenew text end is available to a deleted text beginchilddeleted text endnew text begin
person
new text end enrolled in medical assistance who:

(1) has deleted text beginan autism spectrum disorderdeleted text endnew text begin anew text end diagnosisnew text begin of ASD or a related condition that meets
the criteria of subdivision 4
new text end;new text begin and
new text end

deleted text begin (2) has had a diagnostic assessment described in subdivision 5, which recommends early
intensive intervention services; and
deleted text end

deleted text begin (3)deleted text endnew text begin (2)new text end meets the criteria for deleted text beginmedically necessary autism early intensive intervention
services
deleted text endnew text begin medical necessity for the EIDBI benefitnew text end.

new text begin Subd. 3a. new text end

new text begin Culturally and linguistically appropriate requirement. new text end

new text begin The person's and
family's primary spoken language and culture, values, goals, and preferences must be
reflected throughout the covered services. The CMDE provider and QSP must determine
how to adapt the evaluation, treatment recommendations, and individual treatment plan to
the person's and family's culture, values, and language preferences. A provider must have
a limited English proficiency (LEP) plan in compliance with title VI of the Civil Rights Act
of 1964, United States Code, title 42, section 2000d to 2000d-7.
new text end

Subd. 4.

Diagnosis.

(a) A diagnosisnew text begin of ASD or a related conditionnew text end must:

(1) be based upon current DSM criteria including direct observations of the deleted text beginchilddeleted text endnew text begin personnew text end
and deleted text beginreportsdeleted text endnew text begin informationnew text end from deleted text beginparentsdeleted text endnew text begin the person's legal representativenew text end or primary caregivers;
deleted text begin and
deleted text end

(2) be completed by either (i) a licensed physician or advanced practice registered nurse
or (ii) a mental health professionalnew text begin; and
new text end

new text begin (3) meet the requirements of Minnesota Rules, part 9505.0372, subpart 1, items B and
C
new text end.

(b) Additional deleted text begindiagnosticdeleted text end assessment information may be considerednew text begin to complete a
diagnostic assessment
new text end including deleted text beginfromdeleted text endnew text begin specialized tests administered throughnew text end 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.new text begin
A diagnostic assessment may include treatment recommendations.
new text end

Subd. 5.

deleted text beginDiagnostic assessmentdeleted text endnew text begin Comprehensive multidisciplinary evaluationnew text end.

deleted text beginThe
following
deleted text endnew text begin (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.
new text end Information and assessments must be performed, reviewed, and relied
upon for the eligibility determination, treatment and services recommendations, and treatment
plan development for the deleted text beginchild:deleted text endnew text begin person.
new text end

new text begin (b) The CMDE must:
new text end

(1) new text begininclude new text endan assessment of the deleted text beginchild'sdeleted text endnew text begin person'snew text end developmental skills, functional behavior,
needs, and capacities based on direct observation of the deleted text beginchilddeleted text endnew text begin personnew text end which must be
administered by a deleted text beginlicensed mental health professionaldeleted text endnew text begin CMDE providernew text end, deleted text beginmustdeleted text end include medical
or assessment information from the deleted text beginchild'sdeleted text endnew text begin person'snew text end physician or advanced practice registered
nurse, and may also include deleted text beginobservationsdeleted text endnew text begin inputnew text end 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 new text beginor habilitation new text endtherapists, licensed
school personnel, or mental health professionals; deleted text beginand
deleted text end

deleted text begin (2) an assessment of parental or caregiver capacity to participate in therapy including
the type and level of parental or caregiver involvement and training recommended.
deleted text end

new text begin (2) include and document the person's legal representative's or primary caregiver's
preferences for involvement in the person's treatment; and
new text end

new text begin (3) provide information about the range of current EIDBI treatment modalities recognized
by the commissioner.
new text end

new text begin Subd. 5a. new text end

new text begin Comprehensive multidisciplinary evaluation provider qualification. new text end

new text begin A
CMDE provider must:
new text end

new text begin (1) be a licensed physician, advanced practice registered nurse, a mental health
professional, or a mental health practitioner who meets the requirements of a clinical trainee
as defined in Minnesota Rules, part 9505.0371, subpart 5, item C;
new text end

new text begin (2) have at least 2,000 hours of clinical experience in the evaluation and treatment of
people with ASD or a related condition or equivalent documented coursework at the graduate
level by an accredited university in the following content areas: ASD or a related condition
diagnosis, ASD or a related condition treatment strategies, and child development; and
new text end

new text begin (3) be able to diagnose, evaluate, or provide treatment within the provider's scope of
practice and professional license.
new text end

Subd. 6.

new text beginIndividual new text endtreatment plan.

(a) new text beginThe QSP, level I treatment provider, or level
II treatment provider who integrates and coordinates person and family information from
the CMDE and ITP progress monitoring process to develop the ITP must develop and
monitor the ITP.
new text end

new text begin (b) new text endEach deleted text beginchild's treatment plandeleted text endnew text begin person's ITPnew text end must be:

new text begin (1) culturally and linguistically appropriate, as required under subdivision 3a,
individualized, and person-centered; and
new text end

deleted text begin (1)deleted text endnew text begin (2)new text end based on the deleted text begindiagnostic assessmentdeleted text endnew text begin diagnosis and CMDEnew text end information specified
in subdivisions 4 and 5deleted text begin;deleted text endnew text begin.
new text end

deleted text begin (2) coordinated with medically necessary occupational, physical, and speech and language
therapies, special education, and other services the child and family are receiving;
deleted text end

deleted text begin (3) family-centered;
deleted text end

deleted text begin (4) culturally sensitive; and
deleted text end

deleted text begin (5) individualized based on the child's developmental status and the child's and family's
identified needs.
deleted text end

deleted text begin (b)deleted text endnew text begin (c)new text end The deleted text begintreatment plandeleted text endnew text begin ITPnew text end must specify deleted text beginthedeleted text end:

deleted text begin (1) child's goals which are developmentally appropriate, functional, and generalizable;
deleted text end

deleted text begin (2) treatment modality;
deleted text end

deleted text begin (3) treatment intensity;
deleted text end

deleted text begin (4) setting; and
deleted text end

deleted text begin (5) level and type of parental or caregiver involvement.
deleted text end

new text begin (1) the medically necessary treatment and service;
new text end

new text begin (2) the treatment modality that shall be used to meet the goals and objectives, including:
new text end

new text begin (i) baseline measures and projected dates of accomplishment;
new text end

new text begin (ii) the frequency, intensity, location, and duration of each service provided;
new text end

new text begin (iii) the level of legal representative or primary caregiver training and counseling;
new text end

new text begin (iv) any change or modification to the physical and social environments necessary to
provide a service;
new text end

new text begin (v) significant changes in the person's condition or family circumstance;
new text end

new text begin (vi) any specialized equipment or material required;
new text end

new text begin (vii) techniques that support and are consistent with the person's communication mode
and learning style;
new text end

new text begin (viii) the name of the QSP; and
new text end

new text begin (ix) progress monitoring results and goal mastery data; and
new text end

new text begin (3) the discharge criteria that shall be used and a defined transition plan that meets the
requirement of paragraph (g).
new text end

deleted text begin (c)deleted text endnew text begin (d) Implementation ofnew text end the deleted text begintreatmentdeleted text endnew text begin ITPnew text end must be supervised by a deleted text beginprofessional with
expertise and training in autism and child development who is a licensed physician, advanced
practice registered nurse, or mental health professional
deleted text endnew text begin QSPnew text end.

deleted text begin (d)deleted text endnew text begin (e)new text end The deleted text begintreatment plandeleted text endnew text begin ITPnew text end must be submitted to the commissionernew text begin and the person
or the person's legal representative
new text end for approval in a manner determined by the commissioner
for this purpose.

deleted text begin (e) Services authorized must be consistent with the child's approved treatment plan.
deleted text end

new text begin (f) new text enddeleted text beginServicesdeleted text endnew text begin A servicenew text end included in the deleted text begintreatment plandeleted text endnew text begin ITPnew text end must meet all applicable
requirements for medical necessity and coverage.

new text begin (g) To terminate service, the provider must send notice of termination to the person or
the person's legal representative. The transition period begins when the person or the person's
legal representative receives notice of termination from the EIDBI service and ends when
the EIDBI service is terminated. Up to 30 days of continued service is allowed during the
transition period. Services during the transition period shall be consistent with the ITP. The
transition plan shall include:
new text end

new text begin (1) protocols for changing service when medically necessary;
new text end

new text begin (2) how the transition will occur;
new text end

new text begin (3) the time allowed to make the transition; and
new text end

new text begin (4) a description of how the person or the person's legal representative will be informed
of and involved in the transition.
new text end

Subd. 7.

deleted text beginOngoing eligibilitydeleted text endnew text begin Individual treatment plan progress monitoringnew text end.

(a) An
deleted text begin independentdeleted text endnew text begin ITPnew text end progress deleted text beginevaluation conducted by a licensed mental health professional
with expertise and training in autism spectrum disorder and child development
deleted text end new text beginmonitoringnew text end
must be deleted text begincompleteddeleted text endnew text begin submittednew text end after each six months of treatment, or more frequently as
determined by the deleted text begincommissionerdeleted text endnew text begin CMDE provider or QSPnew text end, to determine if progress is being
made toward deleted text beginachievingdeleted text endnew text begin targeted functional andnew text end generalizable goals deleted text beginand meeting functional
goals contained
deleted text endnew text begin specifiednew text end in the deleted text begintreatment plandeleted text endnew text begin 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
new text end.

(b) Thenew text begin ITPnew text end progress deleted text beginevaluationdeleted text end new text beginmonitoringnew text end must include:

deleted text begin (1) the treating provider's report;
deleted text end

deleted text begin (2) parental or caregiverdeleted text endnew text begin (1)new text end inputnew text begin from the person's legal representative or the person's
primary caregiver
new text end;

deleted text begin (3)deleted text endnew text begin (2)new text end an deleted text beginindependentdeleted text end observation of the deleted text beginchild which can bedeleted text endnew text begin person that isnew text end performed
by deleted text beginthe child'sdeleted text endnew text begin the QSP, level I treatment provider, or level II treatment provider and may
include input from
new text end licensed special education staffnew text begin or other licensed health care providernew text end;

new text begin (3) documentation of the person's current level of performance on primary treatment
goal domains including when a goal or objective is achieved, changed, or discontinued;
new text end

new text begin (4) any significant change in the person's condition or family circumstances;
new text end

deleted text begin (4)deleted text endnew text begin (5)new text end any treatment plan deleted text beginmodificationsdeleted text endnew text begin modification and the rationale for any change
made, including treatment modality, intensity, frequency, and duration
new text end; and

deleted text begin (5)deleted text endnew text begin (6)new text end recommendations for continued treatment deleted text beginservicesdeleted text end.

(c)new text begin The ITPnew text end progress deleted text beginevaluationsdeleted text endnew text begin monitoringnew text end must be submitted to the commissioner deleted text beginin
a manner
deleted text endnew text begin and the person or the person's legal representative in a mannernew text end determined by the
commissioner for deleted text beginthis purposedeleted text endnew text begin the reauthorization of EIDBI servicesnew text end.

(d) A deleted text beginchilddeleted text endnew text begin personnew text end who continues to deleted text beginachieve generalizable goals anddeleted text endnew text begin make reasonable
progress toward
new text end treatment goals as specified in the deleted text begintreatment plandeleted text endnew text begin ITPnew text end is eligible to continue
receiving deleted text beginthis benefitdeleted text endnew text begin EIDBI servicesnew text end.

(e) A deleted text beginchild'sdeleted text endnew text begin person'snew text end treatment shall continue during thenew text begin ITPnew text end progress deleted text beginevaluationdeleted text endnew text begin
monitoring
new text end using the process determined under deleted text beginsubdivision 8, clause (8)deleted text endnew text begin this subdivisionnew text end.
Treatment may continue during an appeal pursuant to section 256.045.

Subd. 8.

Refining the benefit with stakeholders.

The commissioner must deleted text begindevelop the
implementation
deleted text endnew text begin refine thenew text end details of the benefit in consultation with stakeholders and consider
recommendations from deleted text beginthe Health Services Advisory Council,deleted text end the Department of Human
Services deleted text beginAutism Spectrum Disorderdeleted text endnew text begin Early Intensive Developmental and Behavioral
Intervention
new text end Advisory Council, the deleted text beginLegislative Autism Spectrum Disorder Task Forcedeleted text endnew text begin early
intensive developmental and behavioral intervention learning collaborative
new text end, and the
deleted text begin Interagency Task Force of thedeleted text end Departments of Health, Education,new text begin Employment and Economic
Development,
new text end and Human Services. deleted text beginThe commissioner must release these details for a
30-day public comment period prior to submission to the federal government for approval.
deleted text end
The deleted text beginimplementationdeleted text end 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 deleted text begintypes ofdeleted text end professionalsnew text begin certified in other treatment approaches recognized by the
department or
new text end trained in deleted text beginautism spectrum disorderdeleted text endnew text begin ASD or a related conditionnew text end and child
development should be added as deleted text beginmental health or otherdeleted text end professionals deleted text beginfor treatmentdeleted text endnew text begin qualified
to provide EIDBI clinical
new text end supervision or other functions under medical assistance;

(2) deleted text begindevelopment of initial,deleted text endnew text begin refinement ofnew text end uniform parameters for deleted text begincomprehensive
multidisciplinary diagnostic assessment information
deleted text endnew text begin CMDEnew text end and deleted text beginprogress evaluationdeleted text endnew text begin ongoing
ITP progress monitoring
new text end standards;

(3) the design of an effective and consistent process for assessing deleted text beginparentdeleted text endnew text begin the person's
and the person's legal representative's
new text end and deleted text begincaregiver capacitydeleted text endnew text begin the person's caregiver's
preferences and options
new text end to participate in the deleted text beginchild'sdeleted text endnew text begin person'snew text end early intervention treatment
andnew text begin efficacy ofnew text end methods deleted text beginof involving the parentsdeleted text endnew text begin to involve and educate the person's legal
representative
new text end and deleted text begincaregiversdeleted text endnew text begin caregivernew text end in the treatment of the deleted text beginchilddeleted text endnew text begin personnew text end;

(4) formulation of a collaborative process in which professionals have opportunities to
collectively inform deleted text begina comprehensive, multidisciplinary diagnostic assessmentdeleted text end new text beginprovider
standards and qualifications; standards for CMDE; medical necessity determination; efficacy
of treatment apparatus, including modality, intensity, frequency, and duration;
new text endand deleted text beginprogress
evaluation
deleted text endnew text begin ITP progress monitoringnew text end processes deleted text beginand standardsdeleted text end to support quality improvement
of deleted text beginearly intensive interventiondeleted text endnew text begin EIDBInew text end services;

(5) coordination of this benefit and its interaction with other services provided by the
Departments of Human Services, Health,new text begin Employment and Economic Development,new text end and
Education;

(6) evaluation, on an ongoing basis, of deleted text beginresearch regarding the programdeleted text endnew text begin EIDBI services
outcomes
new text end andnew text begin efficacy ofnew text end treatment modalities provided to deleted text beginchildrendeleted text endnew text begin peoplenew text end under this benefit;new text begin
and
new text end

(7)new text begin as provided under subdivision 17,new text end determination of the availability of deleted text beginlicensed
physicians, nurse practitioners, and mental health professionals
deleted text endnew text begin qualified EIDBI providersnew text end
withnew text begin necessarynew text end expertise and training in deleted text beginautism spectrum disorderdeleted text endnew text begin ASD or a related conditionnew text end
throughout the state to assess whether there are sufficient professionals deleted text beginto require involvement
of both a physician or nurse practitioner and a mental health professional
deleted text end to providenew text begin timelynew text end
access and prevent delay in the deleted text begindiagnosisdeleted text endnew text begin CMDEnew text end and treatment of deleted text beginyoung children, so as to
implement subdivision 4, and to ensure treatment is effective, timely, and accessible; and
deleted text endnew text begin
a person with ASD or a related condition.
new text end

deleted text begin (8) development of the process for the progress evaluation that will be used to determine
the ongoing eligibility, including necessary documentation, timelines, and responsibilities
of all parties.
deleted text end

Subd. 9.

Revision of treatment options.

(a) The commissioner may revise covered
treatment options as needed based on outcome data and other evidence.new text begin EIDBI treatment
modalities approved by the department must:
new text end

new text begin (1) cause no harm to the person or the person's family;
new text end

new text begin (2) be individualized and person-centered;
new text end

new text begin (3) be developmentally appropriate and highly structured, with well-defined goals and
objectives that provide a strategic direction for treatment;
new text end

new text begin (4) be based in recognized principles of developmental and behavioral science;
new text end

new text begin (5) utilize sound practices that are replicable across providers and maintain the fidelity
of the specific modality;
new text end

new text begin (6) demonstrate an evidentiary basis;
new text end

new text begin (7) have goals and objectives that are measurable, achievable, and be regularly evaluated
and adjusted to ensure that adequate progress is being made;
new text end

new text begin (8) be provided intensively with a high staff-to-person ratio; and
new text end

new text begin (9) include participation by the person and the person's legal representative in decision
making, knowledge building and capacity building, and developing and implementing the
person's ITP.
new text end

(b) Before deleted text beginthe changesdeleted text endnew text begin revisions in department recognized treatment modalitiesnew text end 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 Web site.

Subd. 10.

Coordination between agenciesnew text begin and other benefitsnew text end.

new text begin(a) new text endThe commissioners
of human services and education must develop the capacity to coordinate services and
information including diagnostic, functional, developmental, medical, and educational
assessments; service delivery; and progress evaluations across health and education sectors.

new text begin (b) An EIDBI service provided under this section is not intended to replace a service
provided in school or other settings. A person's ITP must document that EIDBI services
coordinate with, but do not include or replace, special education and related services defined
in the person's individualized education plan (IEP), or individualized family service plan
(IFSP), when the service is available under the Individuals with Disabilities Education
Improvement Act of 2004, United States Code, title 20, chapter 33, through a local education
agency. This provision does not preclude EIDBI treatment during school hours. A program
for birth to three years of age and additional resources must also coordinate with EIDBI
services. A resource for a person over 18 years of age must also be coordinated with EIDBI
services under this section.
new text end

new text begin (c) The commissioner shall integrate medical authorization procedures for an EIDBI
service with authorization procedures for other health and mental health services and home
and community-based services to ensure that the person receives services that are the most
appropriate and effective in meeting the person's needs.
new text end

Subd. 11.

Federal approval of the deleted text beginautismdeleted text endnew text begin EIDBInew text end benefit.

(a) This section shall apply
to state plan services under title XIX of the Social Security Act when federal approval is
granted under a 1915(i) waiver or other authority which allows children eligible for medical
assistance through the TEFRA option under section 256B.055, subdivision 12, to qualify
and includes children eligible for medical assistance in families over 150 percent of the
federal poverty guidelines.

(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 deleted text beginagedeleted text end 20new text begin years of
age
new text end.

Subd. 12.

deleted text beginAutismdeleted text endnew text begin EIDBInew text end benefit; training provided.

After approval of the deleted text beginautism early
intensive intervention
deleted text endnew text begin EIDBInew text end 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 deleted text beginautism servicedeleted text endnew text begin EIDBInew text end
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 new text beginEIDBI new text endbenefit and how to access it.

new text begin Subd. 13. new text end

new text begin Covered services. new text end

new text begin (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.
new text end

new text begin (b) EIDBI modalities include, but are not limited to:
new text end

new text begin (1) applied behavior analysis (ABA);
new text end

new text begin (2) developmental individual-difference relationship-based model (DIR/Floortime);
new text end

new text begin (3) early start Denver model (ESDM);
new text end

new text begin (4) PLAY project; or
new text end

new text begin (5) relationship development intervention (RDI).
new text end

new text begin (c) An EIDBI provider may use one or more of the EIDBI modalities in paragraph (b),
clauses (1) to (5), as the primary modality for treatment as a covered service, or several
EIDBI modalities in combination as the primary modality of treatment, as approved by the
commissioner. An EIDBI provider that identifies and provides assurance of qualifications
for a single specific treatment modality must document the required qualifications to meet
fidelity to the specific model. Additional EIDBI modalities not listed in paragraph (b) may
be covered upon approval by the commissioner.
new text end

new text begin (d) CMDE is a comprehensive evaluation of the person's developmental status to
determine medical necessity for EIDBI services and meets the requirements of subdivision
5. The services must be provided by a qualified CMDE provider.
new text end

new text begin (e) EIDBI intervention observation and direction is the clinical direction and oversight
of EIDBI services by the QSP, level I treatment provider, or level II treatment provider,
including developmental and behavioral techniques, progress measurement, data collection,
function of behaviors, and generalization of acquired skills for the direct benefit of a person.
EIDBI intervention observation and direction informs any modification of the methods to
support the outcomes in the ITP. EIDBI intervention observation and direction provides a
real-time response to EIDBI interventions to maximize the benefit to the person.
new text end

new text begin (f) ITP development and ITP progress monitoring is development of the initial, annual,
and progress monitoring of an ITP. ITP development and ITP progress monitoring
documents, provides oversight and ongoing evaluation of a person's treatment and progress
on targeted goals and objectives, and integrates and coordinates the person's and the person's
legal representative's information from the CMDE and ITP progress monitoring. This service
must be reviewed and completed by the QSP, and may include input from a level I treatment
provider or a level II treatment provider.
new text end

new text begin (g) Family caregiver training and counseling is specialized training and education for a
family or primary caregiver to understand the person's developmental status and help with
the person's needs and development. This service must be provided by the QSP, level I
treatment provider, or level II treatment provider.
new text end

new text begin (h) A coordinated care conference is a voluntary face-to-face meeting with the person
and the person's family to review the CMDE or ITP progress monitoring and to integrate
and coordinate services across providers and service-delivery systems to develop the ITP.
This service must be provided by the QSP and may include the CMDE provider or a level
I treatment provider or a level II treatment provider.
new text end

new text begin (i) Travel time is allowable billing for traveling to and from the person's home, school,
a community setting, or place of service outside of an EIDBI center, clinic, or office from
a specified location to provide face-to-face EIDBI intervention, observation and direction,
or family caregiver training and counseling. The person's ITP must specify the reasons the
provider must travel to the person.
new text end

new text begin (j) Medical assistance covers medically necessary EIDBI services and consultations
delivered by a licensed health care provider via telemedicine, as defined under section
256B.0625, subdivision 3b, in the same manner as if the service or consultation was delivered
in person. Medical assistance coverage is limited to three telemedicine services per person
per calendar week.
new text end

new text begin Subd. 14. new text end

new text begin Person's rights. new text end

new text begin A person or the person's legal representative has the right to:
new text end

new text begin (1) protection as defined under the health care bill of rights under section 144.651;
new text end

new text begin (2) designate an advocate to be present in all aspects of the person's and person's family's
services at the request of the person or the person's legal representative;
new text end

new text begin (3) be informed of the agency policy on assigning staff to a person;
new text end

new text begin (4) be informed of the opportunity to observe the person while receiving services;
new text end

new text begin (5) be informed of services in a manner that respects and takes into consideration the
person's and the person's legal representative's culture, values, and preferences in accordance
with subdivision 3a;
new text end

new text begin (6) be free from seclusion and restraint, except for emergency use of manual restraint
in emergencies as defined in section 245D.02, subdivision 8a;
new text end

new text begin (7) be under the supervision of a responsible adult at all times;
new text end

new text begin (8) be notified by the agency within 24 hours if an incident occurs or the person is injured
while receiving services, including what occurred and how agency staff responded to the
incident;
new text end

new text begin (9) request a voluntary coordinated care conference; and
new text end

new text begin (10) request a CMDE provider of the person's or the person's legal representative's
choice.
new text end

new text begin Subd. 15. new text end

new text begin EIDBI provider qualifications. new text end

new text begin (a) A QSP must be employed by an agency
and be:
new text end

new text begin (1) a licensed mental health professional who has at least 2,000 hours of supervised
clinical experience or training in examining or treating people with ASD or a related condition
or equivalent documented coursework at the graduate level by an accredited university in
ASD diagnostics, ASD developmental and behavioral treatment strategies, and typical child
development; or
new text end

new text begin (2) a developmental or behavioral pediatrician who has at least 2,000 hours of supervised
clinical experience or training in examining or treating people with ASD or a related condition
or equivalent documented coursework at the graduate level by an accredited university in
the areas of ASD diagnostics, ASD developmental and behavioral treatment strategies, and
typical child development.
new text end

new text begin (b) A level I treatment provider must be employed by an agency and:
new text end

new text begin (1) have at least 2,000 hours of supervised clinical experience or training in examining
or treating people with ASD or a related condition or equivalent documented coursework
at the graduate level by an accredited university in ASD diagnostics, ASD developmental
and behavioral treatment strategies, and typical child development or an equivalent
combination of documented coursework or hours of experience; and
new text end

new text begin (2) have or be at least one of the following:
new text end

new text begin (i) a master's degree in behavioral health or child development or related fields including,
but not limited to, mental health, special education, social work, psychology, speech
pathology, or occupational therapy from an accredited college or university;
new text end

new text begin (ii) a bachelor's degree in a behavioral health, child development, or related field
including, but not limited to, mental health, special education, social work, psychology,
speech pathology, or occupational therapy, from an accredited college or university, and
advanced certification in a treatment modality recognized by the department;
new text end

new text begin (iii) a board certified behavior analyst; or
new text end

new text begin (iv) a board-certified assistant behavior analyst with 4,000 hours of supervised clinical
experience that meets all registration, supervision, and continuing education requirements
of the certification.
new text end

new text begin (c) A level II treatment provider must be employed by an agency and must be:
new text end

new text begin (1) a person who has a bachelor's degree from an accredited college or university in a
behavioral or child development science or related field including, but not limited to, mental
health, special education, social work, psychology, speech pathology, or occupational
therapy; and meet at least one of the following:
new text end

new text begin (i) has at least 1,000 hours of supervised clinical experience or training in examining or
treating people with ASD or a related condition or equivalent documented coursework at
the graduate level by an accredited university in ASD diagnostics, ASD developmental and
behavioral treatment strategies, and typical child development or a combination of
coursework or hours of experience;
new text end

new text begin (ii) certification as a board-certified assistant behavior analyst from the Behavior Analyst
Certification Board;
new text end

new text begin (iii) is a registered behavior technician as defined by the Behavior Analyst Certification
Board; or
new text end

new text begin (iv) is certified in one of the other treatment modalities recognized by the department;
or
new text end

new text begin (2) a person who has:
new text end

new text begin (i) an associate's degree in a behavioral or child development science or related field
including, but not limited to, mental health, special education, social work, psychology,
speech pathology, or occupational therapy from an accredited college or university; and
new text end

new text begin (ii) at least 2,000 hours of supervised clinical experience in delivering treatment to people
with ASD or a related condition. Hours worked as a mental health behavioral aide or level
III treatment provider may be included in the required hours of experience; or
new text end

new text begin (3) a person who has at least 4,000 hours of supervised clinical experience in delivering
treatment to people with ASD or a related condition. Hours worked as a mental health
behavioral aide or level III treatment provider may be included in the required hours of
experience; or
new text end

new text begin (4) a person who is a graduate student in a behavioral science, child development science,
or related field and is receiving clinical supervision by a QSP affiliated with an agency to
meet the clinical training requirements for experience and training with people with ASD
or a related condition; or
new text end

new text begin (5) a person who is at least 18 years of age and who:
new text end

new text begin (i) is fluent in a non-English language;
new text end

new text begin (ii) completed the level III EIDBI training requirements; and
new text end

new text begin (iii) receives observation and direction from a QSP or level I treatment provider at least
once a week until the person meets 1,000 hours of supervised clinical experience.
new text end

new text begin (d) A level III treatment provider must be employed by an agency, have completed the
level III training requirement, be at least 18 years of age, and have at least one of the
following:
new text end

new text begin (1) a high school diploma or general equivalency diploma (GED);
new text end

new text begin (2) fluency in a non-English language; or
new text end

new text begin (3) one year of experience as a primary personal care assistant, community health worker,
waiver service provider, or special education assistant to a person with ASD or a related
condition within the previous five years.
new text end

new text begin Subd. 16. new text end

new text begin Agency duties. new text end

new text begin (a) An agency delivering an EIDBI service under this section
must:
new text end

new text begin (1) enroll as a medical assistance Minnesota health care program provider according to
Minnesota Rules, part 9505.0195, and section 256B.04, subdivision 21, and meet all
applicable provider standards and requirements;
new text end

new text begin (2) demonstrate compliance with federal and state laws for EIDBI service;
new text end

new text begin (3) verify and maintain records of a service provided to the person or the person's legal
representative as required under Minnesota Rules, parts 9505.2175 and 9505.2197;
new text end

new text begin (4) demonstrate that while enrolled or seeking enrollment as a Minnesota health care
program provider the agency did not have a lead agency contract or provider agreement
discontinued because of a conviction of fraud; or did not have an owner, board member, or
manager fail a state or federal criminal background check or appear on the list of excluded
individuals or entities maintained by the federal Department of Human Services Office of
Inspector General;
new text end

new text begin (5) have established business practices including written policies and procedures, internal
controls, and a system that demonstrates the organization's ability to deliver quality EIDBI
services;
new text end

new text begin (6) have an office located in Minnesota;
new text end

new text begin (7) conduct a criminal background check on an individual who has direct contact with
the person or the person's legal representative;
new text end

new text begin (8) report maltreatment according to sections 626.556 and 626.557;
new text end

new text begin (9) comply with any data requests consistent with the Minnesota Government Data
Practices Act, sections 256B.064 and 256B.27;
new text end

new text begin (10) provide training for all agency staff on the requirements and responsibilities listed
in the Maltreatment of Minors Act, section 626.556, and the Vulnerable Adult Protection
Act, section 626.557, including mandated and voluntary reporting, nonretaliation, and the
agency's policy for all staff on how to report suspected abuse and neglect;
new text end

new text begin (11) have a written policy to resolve issues collaboratively with the person and the
person's legal representative when possible. The policy must include a timeline for when
the person and the person's legal representative will be notified about issues that arise in
the provision of services;
new text end

new text begin (12) provide the person's legal representative with prompt notification if the person is
injured while being served by the agency. An incident report must be completed by the
agency staff member in charge of the person. A copy of all incident and injury reports must
remain on file at the agency for at least five years from the report of the incident; and
new text end

new text begin (13) before starting a service, provide the person or the person's legal representative a
description of the treatment modality that the person shall receive, including the staffing
certification levels and training of the staff who shall provide a treatment.
new text end

new text begin (b) When delivering the ITP, and annually thereafter, an agency must provide the person
or the person's legal representative with:
new text end

new text begin (1) a written copy and a verbal explanation of the person's or person's legal
representative's rights and the agency's responsibilities;
new text end

new text begin (2) document 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
new text end

new text begin (3) reasonable accommodations to provide the information in another format or language
as needed to facilitate understanding of the person's or person's legal representative's rights
and the agency's responsibilities.
new text end

new text begin Subd. 17. new text end

new text begin Provider shortage; authority for exceptions. new text end

new text begin (a) In consultation with the
Early Intensive Developmental and Behavioral Intervention Advisory Council and
stakeholders, including agencies, professionals, parents of people with ASD or a related
condition, and advocacy organizations, the commissioner shall determine if a shortage of
EIDBI providers exists. For the purposes of this subdivision, "shortage of EIDBI providers"
means a lack of availability of providers who meet the EIDBI provider qualification
requirements under subdivision 15 that results in the delay of access to timely services under
this section, or that significantly impairs the ability of a provider agency to have sufficient
providers to meet the requirements of this section. The commissioner shall consider
geographic factors when determining the prevalence of a shortage. The commissioner may
determine that a shortage exists only in a specific region of the state, multiple regions of
the state, or statewide. The commissioner shall also consider the availability of various types
of treatment modalities covered under this section.
new text end

new text begin (b) The commissioner, in consultation with the Early Intensive Developmental and
Behavioral Intervention Advisory Council and stakeholders, must establish processes and
criteria for granting an exception under this paragraph. The commissioner may grant an
exception only if the exception would not compromise a person's safety and not diminish
the effectiveness of the treatment. The commissioner may establish an expiration date for
an exception granted under this paragraph. The commissioner may grant an exception for
the following:
new text end

new text begin (1) EIDBI provider qualifications under this section;
new text end

new text begin (2) medical assistance provider enrollment requirements under section 256B.04,
subdivision 21; or
new text end

new text begin (3) EIDBI provider or agency standards or requirements.
new text end

new text begin (c) If the commissioner, in consultation with the Early Intensive Developmental and
Behavioral Intervention Advisory Council and stakeholders, determines that a shortage no
longer exists, the commissioner must submit a notice that a shortage no longer exists to the
chairs and ranking minority members of the senate and the house of representatives
committees with jurisdiction over health and human services. The commissioner must post
the notice for public comment for 30 days. The commissioner shall consider public comments
before submitting to the legislature a request to end the shortage declaration. The
commissioner shall annually provide an update on the status of the provider shortage and
exceptions granted to the chairs and ranking minority members of the senate and house of
representatives committees with jurisdiction over health and human services. The
commissioner shall not declare the shortage of EIDBI providers ended without direction
from the legislature to declare it ended.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin Subdivisions 15 and 17 are effective the day following final
enactment. Subdivisions 1 to 9, 13, 14, and 16 are effective July 1, 2017.
new text end