S.F. No. 2751 adds new language concerning a benefit for the treatment of children with autism spectrum disorders and related conditions.  Some of the language, particularly the language concerning provider standards, comes from the Medical Assistance state plan amendment that adds this benefit to Minnesota’s state plan.  Other language concerning eligibility is required by federal law. Other new language specifies the rights of service recipients and the duties of providers.

Section 1 (256B.0949, subdivision 1) changes the name of the existing autism early intensive intervention benefit to the Early Intensive Developmental and Behavioral Intervention (EIDBI) benefit and includes language specifying that the benefit is also available for the treatment of conditions related to autism spectrum disorders (ASD).

Subdivision 2 includes several new definitions, including definitions of “agency,” “ASD and related conditions,” “clinical supervision,” “comprehensive multidisciplinary evaluation,” “Individual treatment plan,” “legal representative,” and definitions by cross-reference for various EIDBI professionals and providers.

Subdivision 3 modifies the eligibility criteria for the EIDBI benefit by allowing children with diagnoses of a condition related to an autism spectrum disorder to be eligible and by adding the requirement that the child be medically stable and not need 24-hour medical care.

Subdivision 3a requires providers to ensure that children and their families receive EIBDI services in a culturally and linguistically appropriate manner.

Subdivision 4 specifies the conditions a diagnosis of ASD or a related condition must meet and information that may be included in a diagnostic assessment.

Subdivision 5 requires a comprehensive multidisciplinary evaluation (CMDE) of potential service recipients be completed by a qualified provider to determine if EIDBI services are medically necessary; specifies what must be included in the evaluation; and requires that the evaluation be updated at least every 12 month.

Subdivision 5a specifies the CMDE provider qualification requirements.

Subdivision 6 requires an EIDBI professional, other than a level III treatment provider, to develop and monitor a child’s individual treatment plan and specifies the required elements of an individual treatment plan.

Subdivision 6a specifies that EIDBI services may not replace services defined in a child’s individualized education plan and requires the commissioner to take steps to ensure that all the benefits received by a child receiving EIDBI services are comprehensively integrated.

Subdivision 7 requires that a child’s progress toward achieving treatment goals is evaluated at least every six month and specifies who must supervise the evaluation and the required elements of the evaluation.

Subdivision 8 requires the commissioner to work with stakeholders to continue to refine the details of the EIBDI benefit and incorporates new language and terminology into the list of suggested issues the commissioner could consider.

Subdivision 9 specifies the requirements for any treatment method must meet to be a recognized treatment option for the purposes of the EIDBI benefit.

Subdivision 10 is existing language.

Subdivision 11 is existing language.

Subdivision 12 is existing language.

Subdivision 13 lists and describes the services covered by the EIDBI benefit.

Subdivision 14 lists and describes services not covered by the EIDBI benefit.

Subdivision 15 lists the rights of children and of their families receiving the EIDBI benefit.

Subdivision 16 specifies the provider qualification requirements for each of the following EIBDI providers: level I treatment providers; level II treatment providers; level III treatment providers; and qualified supervising professionals.

Subdivision 17 lists and describes the duties and responsibilities of an agency, which may include an individual who acts as an agency.

Subdivision 18 specifies that the rights of a child listed in subdivision 15 may be restricted only if the restriction is necessary to ensure the health, safety, and well-being of the child, or to support the therapeutic goals in the child’s individual treatment plan.

Subdivision 19 lists and describes the agency qualifications requirements, as well as additional duties and responsibilities of agencies.

Subdivision 20 lists and describes the administrative infrastructure requirements for agencies, which include various written policies and procedures, and required staff orientation and training.

Subdivision 21 requires providers to allow the commissioner access to documents and records when the commissioner is investigating possible overpayments of Medicaid funds, and specifies that the failure to comply with this requirement may result in the immediate suspension of payments and termination of the provider’s enrollment as a Medical Assistance provider.

Subdivision 22 requires the commissioner to consult with stakeholders to determine if there exists a shortage of qualified providers of EIDBI services, and if so, to develop a process and criteria for granting nonqualified EIDBI providers or nonqualified CMDE providers exceptions to their respective provider qualification requirements. The commissioner is required to provide annual updates to the legislature concerning the status of the shortage of qualified EIBDI providers and the use of the qualification exception process.  The commissioner may not terminate the exemption authority without providing 30 days’ notice for public comment.