Chapter 19

Subdivision 1.

Purpose.

This section deleted text begin creates a new benefitdeleted text end new text begin authorizes the early intensive developmental and behavioral intervention (EIDBI) benefitnew text end to provide early intensive intervention to a deleted text begin childdeleted text end new text begin personnew text end with an autism spectrum disorder deleted text begin diagnosisdeleted text end new text begin or a related conditionnew text end . This benefit must provide coverage for deleted text begin diagnosisdeleted text end new text begin a comprehensivenew text end , multidisciplinary deleted text begin assessmentdeleted text end new text begin evaluationnew text end , ongoing progress deleted text begin evaluationdeleted text end new text begin monitoringnew 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 supportsnew text end .

Subd. 2.

Definitions.

(a) deleted text begin For the purposes of this section,deleted text end The terms deleted text begin defineddeleted text end new text begin usednew text end in this deleted text begin subdivisiondeleted text end new 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 end new text begin (d)new text end "deleted text begin Childdeleted text end new text begin Personnew text end " means a person under deleted text begin the age of 18deleted text end new 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 end new 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 end new 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 begin autism treatment optionsdeleted text end new text begin a variety of individualized, intensive treatment modalities approved by the commissioner that arenew 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 modelsdeleted text end new text begin consistent with best practices on effectivenessnew text end .

deleted text begin (f)deleted text end new 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 begin childrendeleted text end new 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 end new 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 begin Initialdeleted text end new text begin EIDBInew text end eligibility.

deleted text begin This benefitdeleted text end new text begin An EIDBI servicenew text end is available to a deleted text begin childdeleted text end new text begin personnew text end enrolled in medical assistance who:

(1) has deleted text begin an autism spectrum disorderdeleted text end new text begin anew text end diagnosisnew text begin of ASD or a related condition that meets the criteria of subdivision 4new text end ;new text begin andnew 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 end new text begin (2)new text end meets the criteria for deleted text begin medically necessary autism early intensive intervention servicesdeleted text end new 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 begin childdeleted text end new text begin personnew text end and deleted text begin reportsdeleted text end new text begin informationnew text end from deleted text begin parentsdeleted text end new text begin the person's legal representativenew text end or primary caregivers; deleted text begin anddeleted text end

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

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

(b) Additional deleted text begin diagnosticdeleted text end assessment information may be considerednew text begin to complete a diagnostic assessmentnew text end including deleted text begin fromdeleted text end new 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 begin Diagnostic assessmentdeleted text end new text begin Comprehensive multidisciplinary evaluationnew text end .

deleted text begin The followingdeleted text end new 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 begin child:deleted text end new text begin person.new text end

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

(1) new text begin include new text end an assessment of the deleted text begin child'sdeleted text end new text begin person'snew text end developmental skills, functional behavior, needs, and capacities based on direct observation of the deleted text begin childdeleted text end new text begin personnew text end which must be administered by a deleted text begin licensed mental health professionaldeleted text end new text begin CMDE providernew text end , deleted text begin mustdeleted text end include medical or assessment information from the deleted text begin child'sdeleted text end new text begin person'snew text end physician or advanced practice registered nurse, and may also include deleted text begin observationsdeleted text end new 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 begin or habilitation new text end therapists, licensed school personnel, or mental health professionals; deleted text begin anddeleted 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 begin Individual new text end treatment plan.

(a) new text begin The 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 end Each deleted text begin child's treatment plandeleted text end new 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 end new text begin (2)new text end based on the deleted text begin diagnostic assessmentdeleted text end new text begin diagnosis and CMDEnew text end information specified in subdivisions 4 and 5deleted text begin ;deleted text end new 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 end new text begin (c)new text end The deleted text begin treatment plandeleted text end new text begin ITPnew text end must specify deleted text begin thedeleted 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 end new text begin (d) Implementation ofnew text end the deleted text begin treatmentdeleted text end new text begin ITPnew text end must be supervised by a deleted text begin professional with expertise and training in autism and child development who is a licensed physician, advanced practice registered nurse, or mental health professionaldeleted text end new text begin QSPnew text end .

deleted text begin (d)deleted text end new text begin (e)new text end The deleted text begin treatment plandeleted text end new text begin ITPnew text end must be submitted to the commissionernew text begin and the person or the person's legal representativenew 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 end deleted text begin Servicesdeleted text end new text begin A servicenew text end included in the deleted text begin treatment plandeleted text end new 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 begin Ongoing eligibilitydeleted text end new text begin Individual treatment plan progress monitoringnew text end .

(a) An deleted text begin independentdeleted text end new text begin ITPnew text end progress deleted text begin evaluation conducted by a licensed mental health professional with expertise and training in autism spectrum disorder and child developmentdeleted text end new text begin monitoringnew text end must be deleted text begin completeddeleted text end new text begin submittednew text end after each six months of treatment, or more frequently as determined by the deleted text begin commissionerdeleted text end new text begin CMDE provider or QSPnew text end , to determine if progress is being made toward deleted text begin achievingdeleted text end new text begin targeted functional andnew text end generalizable goals deleted text begin and meeting functional goals containeddeleted text end new text begin specifiednew text end in the deleted text begin treatment plandeleted text end new 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 servicesnew text end .

(b) Thenew text begin ITPnew text end progress deleted text begin evaluationdeleted text end new text begin monitoringnew text end must include:

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

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

deleted text begin (3)deleted text end new text begin (2)new text end an deleted text begin independentdeleted text end observation of the deleted text begin child which can bedeleted text end new text begin person that isnew text end performed by deleted text begin the child'sdeleted text end new text begin the QSP, level I treatment provider, or level II treatment provider and may include input fromnew 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 end new text begin (5)new text end any treatment plan deleted text begin modificationsdeleted text end new text begin modification and the rationale for any change made, including treatment modality, intensity, frequency, and durationnew text end ; and

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

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

(d) A deleted text begin childdeleted text end new text begin personnew text end who continues to deleted text begin achieve generalizable goals anddeleted text end new text begin make reasonable progress towardnew text end treatment goals as specified in the deleted text begin treatment plandeleted text end new text begin ITPnew text end is eligible to continue receiving deleted text begin this benefitdeleted text end new text begin EIDBI servicesnew text end .

(e) A deleted text begin child'sdeleted text end new text begin person'snew text end treatment shall continue during thenew text begin ITPnew text end progress deleted text begin evaluationdeleted text end new text begin monitoringnew text end using the process determined under deleted text begin subdivision 8, clause (8)deleted text end new 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 begin develop the implementationdeleted text end new text begin refine thenew text end details of the benefit in consultation with stakeholders and consider recommendations from deleted text begin the Health Services Advisory Council,deleted text end the Department of Human Services deleted text begin Autism Spectrum Disorderdeleted text end new text begin Early Intensive Developmental and Behavioral Interventionnew text end Advisory Council, the deleted text begin Legislative Autism Spectrum Disorder Task Forcedeleted text end new text begin early intensive developmental and behavioral intervention learning collaborativenew 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 begin The 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 begin implementationdeleted 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 begin types ofdeleted text end professionalsnew text begin certified in other treatment approaches recognized by the department or new text end trained in deleted text begin autism spectrum disorderdeleted text end new text begin ASD or a related conditionnew text end and child development should be added as deleted text begin mental health or otherdeleted text end professionals deleted text begin for treatmentdeleted text end new text begin qualified to provide EIDBI clinicalnew text end supervision or other functions under medical assistance;

(2) deleted text begin development of initial,deleted text end new text begin refinement ofnew text end uniform parameters for deleted text begin comprehensive multidisciplinary diagnostic assessment informationdeleted text end new text begin CMDEnew text end and deleted text begin progress evaluationdeleted text end new text begin ongoing ITP progress monitoringnew text end standards;

(3) the design of an effective and consistent process for assessing deleted text begin parentdeleted text end new text begin the person's and the person's legal representative's new text end and deleted text begin caregiver capacitydeleted text end new text begin the person's caregiver's preferences and optionsnew text end to participate in the deleted text begin child'sdeleted text end new text begin person'snew text end early intervention treatment andnew text begin efficacy ofnew text end methods deleted text begin of involving the parentsdeleted text end new text begin to involve and educate the person's legal representativenew text end and deleted text begin caregiversdeleted text end new text begin caregivernew text end in the treatment of the deleted text begin childdeleted text end new text begin personnew text end ;

(4) formulation of a collaborative process in which professionals have opportunities to collectively inform deleted text begin a comprehensive, multidisciplinary diagnostic assessmentdeleted text end new text begin provider standards and qualifications; standards for CMDE; medical necessity determination; efficacy of treatment apparatus, including modality, intensity, frequency, and duration; new text end and deleted text begin progress evaluationdeleted text end new text begin ITP progress monitoringnew text end processes deleted text begin and standardsdeleted text end to support quality improvement of deleted text begin early intensive interventiondeleted text end new 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 begin research regarding the programdeleted text end new text begin EIDBI services outcomesnew text end andnew text begin efficacy ofnew text end treatment modalities provided to deleted text begin childrendeleted text end new text begin peoplenew text end under this benefit;new text begin andnew text end

(7)new text begin as provided under subdivision 17,new text end determination of the availability of deleted text begin licensed physicians, nurse practitioners, and mental health professionalsdeleted text end new text begin qualified EIDBI providersnew text end withnew text begin necessarynew text end expertise and training in deleted text begin autism spectrum disorderdeleted text end new text begin ASD or a related conditionnew text end throughout the state to assess whether there are sufficient professionals deleted text begin to require involvement of both a physician or nurse practitioner and a mental health professionaldeleted text end to providenew text begin timelynew text end access and prevent delay in the deleted text begin diagnosisdeleted text end new text begin CMDEnew text end and treatment of deleted text begin young children, so as to implement subdivision 4, and to ensure treatment is effective, timely, and accessible; anddeleted text end new 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 begin the changesdeleted text end new 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 end The 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 begin autismdeleted text end new 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 begin agedeleted text end 20new text begin years of agenew text end .

Subd. 12.

deleted text begin Autismdeleted text end new text begin EIDBInew text end benefit; training provided.

After approval of the deleted text begin autism early intensive interventiondeleted text end new 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 begin autism servicedeleted text end new 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 begin EIDBI new text end benefit 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

Office of the Revisor of Statutes

Minnesota Session Laws - 2017, Regular Session

Resources

CHAPTER 19--S.F.No. 562

Section 1.

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

256B.0949 deleted text begin AUTISMdeleted text end EARLY INTENSIVEnew text begin DEVELOPMENTAL AND BEHAVIORALnew text end INTERVENTION BENEFIT.