2/11/2016. objectives. The EIDBI Intervention. What is the EIDBI Benefit. Con.. What is unique about Minnesota EIDBI benefit?

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1 objectives The Early Intensive Developmental and Behavioral Intervention (EIDBI) Minn. Stat.265B.0949 Huda Farah The Executive Director of HEAL Institute Participants will learn about The EIDBI Benefit Eligible recipients Covered Services and Service Authorization Medical Necessity Determination Client Rights Service Authorization Provider Qualifications Huda Farah-HEAL Institute The EIDBI Intervention What is the EIDBI Benefit Early Intensive Developmental and Behavioral Interventions (EIDBI): Range of individualized treatments designed to target the core deficits of autism and related conditions. Legal authorization: Minn. Stat. 256B.0949 necessary intensive developmental and behavioral interventions based in current science. Address or treat functional skills and core deficits of children with autism spectrum disorder or related conditions, Are for individuals with persistent, clinically significant impairment in social communication and behavioral self-regulation and other areas of functional development for which this service is medically appropriate. What is unique about Minnesota EIDBI benefit? Targets early identification and early intervention while extending service to wider age range Con.. Is provided directly to the child or on behalf of the child by training the parents/primary caregivers Comprehensive and coordinates care across all needed services It recognizes the essential role of family and caregivers in the child s life, development and treatment Promotes the child s optimal independence and participation in family, school and community life and improves long-term outcomes and quality of life for children with autism and their families. Individualized based on the values, goals, preferences, language and culture of each child and family 1

2 ABA Interventions DBI Interventions ABA Individualized treatments based in behavioral sciences DBI interventions are individualized treatments based in developmental theory and behavioral sciences Focus on teaching specific skills to increase positive, useful behaviors while decreasing negative or harmful behaviors that interfere with learning ABA also mitigates factors in a person s environment that undermine success and teach different, more appropriate ways to responding. Capitalize on natural motivators such as affect and primary relationships to promote the child s development Socially directed and highly engaging Who is eligible? Following individuals are eligible for EIDBI: Condition results in substantial functional limitations in three core deficits of autism spectrum disorder and may include one or more of the following: Children from birth to age 21 Have autism spectrum disorder or related condition On Medical Assistance including MA-managed care and MA TEFRA Meet medical necessity as determined through a Comprehensive Multi- Disciplinary Evaluation (CMDE) conducted by a qualified provider. 1) sensory processing 2) self-care 3) behavioral challenges 4) expressive communication 5) receptive communication 6) cognitive functioning 7) safety and 8) describes level of support needed Eligibility Medical Necessity Determination Related condition is defined as a condition found to be closely related to autism spectrum disorder including, but not limited to autism, Asperger s syndrome, pervasive developmental disorder-not otherwise specified, fetal alcohol spectrum disorder, Rhett s syndrome and autism related diagnosis as identified under the DSM IV. Through the comprehensive Multi-Disciplinary Evaluation Symptoms present in the early developmental period (may not become fully manifest until later age) 2

3 Covered Services Covered services: Telemedicine All covered activities and services must be for the direct benefit of a child. They include: Comprehensive multi-disciplinary evaluation (CMDE) Coordinated care conference EIDBI Intervention (treatment modalities) Family/caregiver training and counseling Individual treatment plan development and monitoring Intervention observation and direction. You may use two-way, interactive video to provide the following services if medically appropriate to the condition and needs of the child. Services include: Comprehensive multi-disciplinary evaluation (CMDE) Coordinated care conference Family/caregiver training and counseling Intervention observation and direction. You must be physically face-to-face or virtually face-to-face via the interactive video. Either the child or family must be present. Interactive systems must comply with HIPAA privacy, security requirements and regulations Service Authorization Non-covered Services EIDBI intervention, intervention observation and direction, travel time, family/caregiver training and counseling require service authorization. Authorization is not required for services if needed for the evaluation, coordinated care conference and development of the initial treatment plan. Conducted over the telephone, postal mail or s Not delivered Not documented in the individual treatment plan Not real time or face-to-face either physically or via interactive video (except for treatment plan development) Primarily custodial, daycare or respite Primarily recreation oriented in a setting not medically supervised* Provided by a parent, legal guardian or legally responsible person. Provided by people who do not meet the qualifications Provided in violation of medical assistance policy in Minn. R, part (General MA excluded services provision) Provided to the general community (Such as prevention or education programs) Provided without the required supervision Reporting, charting and record keeping, except where this is an integral part of a CMDE or ITP Development and Monitoring service Services that include or replace academic goals and objectives that otherwise are provided through the child's individual education plan or individual family service plan as required under the Individuals with Disabilities Education Improvement Act of Comprehensive Multi-Disciplinary Evaluation (CMDE) A licensed mental health professional or psychiatrist reviews information and assessments to: Determine eligibility Identify treatment and services recommendations Guide development of the treatment plan. 3

4 A licensed mental health professional is responsible to: 1. Assess the child's degree of severity of core features of ASD and related conditions.* 2. Assess the areas of functional development including, cognition, learning and play, social/personal interaction, verbal and non-verbal communication, adaptive, self-help, behavioral self-regulation and motor development.* 3. Discuss the type and level of parent/caregiver training and involvement preferred.* 4. Determine how often to monitor the child s progress. 5. Identify parent/caregiver preferences, family culture, language, goals and values. 6. Identify services the child receives. 7. Integrate current services into recommendations. 8. Identify referrals to other needed services. 9. Present and review treatment modality options with the family. And discuss treatment options and recommend a range of EIDBI treatment intensity necessary for the child to make progress. 10. Review and incorporate the diagnosis and other related assessment information. Must complete assessments face-to-face or via telemedicine. Medical and assessment information may come from the child's physician or advanced practice registered nurse. Criteria for DHS recognized treatment modalities DHS Recognized Treatment modalities DHS will use this criteria to evaluate for payment: DHS treatment modalities are approved as covered services: Based on recognized principles of developmental and behavioral science Developmentally appropriate, highly structured with targeted goals Provided intensively with a high adult to child ratio Regularly evaluated and adjusted as needed Cause no harm to the child or family Demonstrates level of evidentiary basis Includes family participation Provides a strategic direction for treatment Uses sound practices that are replicable across providers and maintain the fidelity of the specific treatment approach. Applied Behavioral Analysis (ABA) Developmental Individual-difference Relationship-based model (DIR /Floortime) Early Start Denver Model (ESDM) P.L.A.Y Project Relationship Development Intervention (RDI) Coordinated Care Conference What happens in the CCC? The care conference reviews the results of the CMDE, progress monitoring and other service updates. Coordinated care conference is a covered service under EIDBI In this process a team of professionals that works with the child and family meet to develop and coordinate the implementation of the individual treatment plan (ITP) and integrate services across providers and service delivery systems. This is consider as a best practice for children with complex health needs who access multiple services. The coordinated care conference is optional based on parent request only. Coordinate and integrate information from the CMDE process Recommend intensive treatment scope, modality, intensity, frequency and duration and document in the individual treatment plan Review the child s progress toward goals with the child s family Coordinate services provided to the child and family Identify the level and type of parent involvement in the child s intensive treatment Integrate care and services across service providers to ensure access to appropriate and necessary care including medically necessary speech therapy, occupational therapy, mental health, human services or special education Make referrals to other services when needed 4

5 Coordinated Care Conference Coordinated Care Conference The following people must be included in the care conference: Child or parents Qualified Supervising Professional (QSP) Additionally, the following people may be included in the care conference: EIDBI provider(s) Comprehensive multi-disciplinary evaluation (CMDE) provider Family members and child care providers Licensed professionals that work with child Other mental health professionals Rehabilitative services or other providers School personnel The QSP is responsible to: 1. Schedule the coordinated care conference. 2. Coordinate conference date and time with family. 3. Notify other service providers who need to attend the meeting. 4. Arrange for interpreter as needed. The care conference occurs: After the completion of the CMDE In conjunction with initial and annual ITP development Only one time per year. EIDBI Family/Caregiver Training EIDBI Family/Caregiver Training..Con. Family/caregiver training and counseling is a specialized training and education a family or primary caregiver receives to help with their child's needs and development. Family caregiver training and counseling helps family and caregivers: Increase family resilience Learn how to access supports Understand available resources Understand their child s condition. I. Services must be: Culturally and linguistically appropriate Meaningful to the child and family. Must be provided by QSP, level I or II II. The following are covered activities: Direct hands-on demonstration/modeling of effective strategies to support the child s development Reflection, feedback and support Services that improve parent-identified quality of life issues for child, parent and family Video Modeling and review. EIDBI clinical supervision EIDBI clinical supervision means the overall responsibility for the control and direction of individualized treatment planning, service delivery, and treatment review for each client. Clinical supervision can only be done by a qualified supervising professional (QSP) The QSP accepts full professional responsibility for the supervisees' actions and decisions, instructs the supervisee in the supervisee's work, and oversees or directs the supervisee's work Complies with the standards of the QSP's licensing board All EIDBI services must be billed by, and either provided by or under the clinical supervision of a qualified supervising professional who assumes full professional responsibility for the services provided by Level I, II and III ABA or DBI Developmental/Behavioral providers. EIDBI requires at least 1 hour per month of supervision for each level II and III provider. The QSP must provide written documentation of the supervision plan including nature, frequency, method and when a change of supervision occurs. 5

6 Observation and Direction Individual Treatment Plan (ITP) Face to-face clinical direction and oversight by a qualified EIDBI provider to a lower level provider Informs any modifications needed to support the accomplishment of outcomes in the ITP; For the direct benefit of and to maximize the benefit of EIDBI for the child. Individual Treatment Plan is the development and monitoring of the individual treatment plan by the qualified EIDBI professionals who integrate and coordinate child and family information from the comprehensive multi-disciplinary evaluation (CMDE) process to develop the individual treatment plan. Provider Qualifications Individual treatment plans must: Be person-centered and individualized based on the child's developmental status and identified needs, interests, values, preferences, culture, and language Identify desired outcomes of the child and their legal representative Specify functional goals which are developmentally appropriate and work toward generalization across people and environments for best possible participation in home, school and community life Identify level of primary caregiver/responsible adult training and support Assure delivery in a manner individualized to the child and family, to ensure skills transfer to the parent/caregiver The QSP provider must: Be a licensed mental health professional (insert link) Work within their licensed scope of practice Have at least 2,000 hours of experience and/or training in the examination and/or treatment of children with ASD 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. Have a master s degree in one of the behavioral health, child development or allied fields (such as, but not limited to, mental health, special education, social work, psychology, speech pathology, Be certified as a BCBA or BCBA-D Provider Qualifications A level I provider must: Have at least 2,000 hours of clinical experience in the evaluation and treatment of children with autism spectrum disorder (ASD) or Equivalent documented course work at the graduate level by an accredited university in the following content areas: ASD diagnosis, ASD treatment strategies, child development; and For ABA: Have a master s degree in one of the behavioral health, child development or allied fields (such as, but not limited to, mental health, special education, social work, psychology, speech pathology, or occupational therapy) from an accredited college or university, and Be certified as a BCBA or BCBA-D A level I provider must: Have at least 2,000 hours of clinical experience in the evaluation and treatment of children with autism spectrum disorder (ASD) or Equivalent documented course work at the graduate level by an accredited university in the following content areas: ASD diagnosis, ASD treatment strategies, child development; and For DBI provider: Have a master s degree in one of the behavioral health, child development or allied fields (such as, but not limited to, mental health, special education, social work, psychology, speech pathology, or occupational therapy) from an accredited college or university, or Bachelor s degree in one of the behavioral health, child development or allied fields (such as, but not limited to, mental health, special education, social work, psychology, speech pathology, or occupational therapy) from an accredited college or university, and Certification in one of the DHS recognized treatment modalities 6

7 A level II provider must: Provider Qualifications 1. Have at least 2,000 hours of clinical experience in the evaluation and treatment of children with ASD, or 2. Equivalent documented course-work at the graduate level by an accredited university in the following content areas: ASD diagnosis, ASD treatment strategies, child development, or 3. Be fluent in the non-english language of the ethnic group to which at least 50 percent of the practitioner's clients belong, and Meet the Department s ASD specific training requirements, and The practitioner must also receive observation and direction from a qualified supervising professional or qualified Level I ABA or DBI at least once a week until the requirement of 2,000 hours of supervised experience is met A level III provider must: 1. Be at least 18 years old 2. Meet the Department s ASD specific training requirements; and 3. Have a high school diploma or general equivalency diploma (GED) or: Be fluent in the non-english language of the ethnic group to which at least 50 percent of the practitioner's clients belong; or Have two years of experience as a primary caregiver to a child with autism spectrum disorder within the previous five years; or Be a Registered Behavior Technician (RBT) as defined by the Behavior Analyst Certification Board Progress Monitoring Progress monitoring Progress monitoring must: Progress monitoring is the evaluation, data collection and documentation of the child's progress toward identified goals and objectives identified in the EIDBI individual treatment plan (ITP). Progress is evaluated every six months or more frequently as specified in the ITP to ensure that adequate progress is being made. The ITP is revised as needed to document medical necessity for EIDBI treatment. Service authorizations are valid for up to 12 months or 366 days. Requests for authorization of service must be received 15 business days prior to the end of the current service authorization to assure continuation of EIDBI treatment. Evaluate child progress toward individualized, developmentally appropriate goals and objectives on the ITP and generalization across people and environments. Update and document progress on the ITP toward specific goals and objectives including percent of achievement on each identified goal Review ITP goals and objectives progress with the child's parent/legal representative Modify the ITP including individual goals and objectives, service intensity, frequency, duration, modality or setting, and discharge criteria based on results of the progress evaluation in consultation with the child's parent/legal representative. Document child's continued medical necessity for EIDBI services and/or referral to other services as needed Provider Qualifications EIDBI Provider Responsibilities The following providers are eligible to provide this service: EIDBI providers are responsible to: Qualified supervising professional Level I Level II Level III Implement specified EIDBI treatment according to the child's identified goals and objectives, amount and level of treating providers needed, and in the intensity, frequency and duration identified on the individual treatment plan. Services must be implemented according to the individual treatment plan under the clinical supervision of the qualified supervising professional 7

8 EIDBI Provider Responsibilities In addition Providers must: Have the appropriate training and be registered with DHS directly or with the affiliated organization 1. Complete and submit authorization 2. Receive authorization approval before services can begin 3. Provide services directly to the child or on behalf of the child by training the parents or primary caregivers The qualified supervising professional is responsible to: 1. Provide direction and oversight to level I, II and III providers. 2. Ensure the Developmental/Behavioral Support Specialist level III provider receives training specific to the person s needs before they provide services. 3. Document the individualized training has occurred in the agency file. 4. Document services provided on staff timesheets and client's case file record Managed Care Organizations paying for the EIDBI Questions and discussion Blue Plus Health Partners Medica Itasca Medical Care Metropolitan Health plan Prime West Health South Country Health Alliance Ucare Thank you For questions please contact DHS Asd.dhs@state.mn.us 8

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