What is EIDBI? Early Intensive Developmental and Behavioral Intervention (EIDBI) is a Minnesota Medical Assistance benefit, created by Minn. Stat. § 256B.0949, that pays for medically necessary treatment for people under 21 who have autism spectrum disorder (ASD) or a related condition. It covers the evaluation that establishes the need, the treatment plan, the intervention itself, clinical supervision of that intervention, and training for the family.
EIDBI is a benefit, not a single therapy. The statute lets a provider deliver treatment through any of four recognized modalities, and every service is delivered by a Level I, II, or III provider under a qualified supervising professional (QSP). Parents, referral sources, and providers meet it at different points, and the Department of Human Services (DHS) regulates it closely.
This guide covers what EIDBI is, who qualifies, how a family gets it, the modalities, settings, and providers, school services and insurance, and the 2025 and 2026 enrollment actions. It is current as of September 2026.
What EIDBI is and what it is not
According to DHS's January 2025 legislative report on EIDBI licensing, the benefit was created in 2013 for children with ASD and related conditions up to age 18 and later expanded to age 21. It sits inside Medical Assistance, Minnesota's Medicaid program, so the rules that govern it are the statute, Minnesota's approved Medicaid state plan, and the DHS EIDBI Benefit Policy Manual.
Under § 256B.0949, subd. 13, an EIDBI service must address the person's medically necessary treatment goals and must be targeted to develop, enhance, or maintain developmental skills in areas such as functional communication, social interaction, restrictive or repetitive behaviors, sensory reactivity, self-regulation, cognition, learning and play, self-care, and safety. The covered services are:
| Covered service | Who delivers it |
|---|---|
| Comprehensive multidisciplinary evaluation (CMDE) | Qualified CMDE provider |
| Intervention (individual, group, or higher provider ratio) | Qualified EIDBI provider under the direction of a QSP |
| Intervention observation and direction | QSP, Level I, or Level II provider |
| ITP development and progress monitoring | Reviewed and completed by the QSP, with Level I or II input |
| Family caregiver training and counseling | QSP, Level I, or Level II provider |
| Coordinated care conference | May include the CMDE provider, QSP, Level I, or Level II provider |
| Travel time and telehealth delivery | Per the ITP and the MHCP telehealth policy |
EIDBI is not a school service, not a waiver service, and not respite or child care. It is also not a synonym for applied behavior analysis; ABA is one way to deliver it.
Who qualifies for EIDBI?
Subd. 3 makes EIDBI available to a person enrolled in Medical Assistance who has a diagnosis of ASD or a related condition that meets subd. 4 and who meets the medical necessity criteria for the benefit. "Person" is defined in subd. 2 as an individual under 21 years of age. The DHS EIDBI manual lists Medical Assistance, MinnesotaCare, and TEFRA as qualifying programs.
A related condition is defined narrowly. It must be severe and chronic, cause impairment of adaptive behavior similar to ASD, require similar treatment, and result in substantial functional limitations in three core areas: social or interpersonal interaction, functional communication, and restrictive or repetitive behaviors or hyperreactivity or hyporeactivity to sensory input.
The diagnosis alone does not make a person eligible. Eligibility is established by the CMDE, which must be completed to determine medical necessity and submitted to the commissioner. The EIDBI CMDE guide covers what the evaluation must contain and who can perform it.
How a family gets EIDBI: referral, CMDE, ITP, authorization
| Step | What happens | Statute |
|---|---|---|
| 1. Diagnosis | A physician, advanced practice registered nurse, physician assistant, or mental health professional completes a diagnostic assessment that meets § 245I.10, subd. 6 | Subd. 4 |
| 2. CMDE | An MHCP-enrolled CMDE provider evaluates the person by direct observation, reviews the diagnosis, gathers medical information, and documents caregiver preferences and the modalities available | Subd. 5 and 5a |
| 3. ITP | The QSP, a Level I, or a Level II provider at an EIDBI agency writes the individual treatment plan from the CMDE, and the QSP supervises its implementation | Subd. 6 |
| 4. Authorization | The ITP is submitted for approval; for fee-for-service Medical Assistance the medical review agent is Acentra Health, and managed care plans run their own process | Subd. 6(e) |
| 5. Treatment and progress monitoring | Intervention begins; progress monitoring is submitted after each six months of treatment, or sooner if the CMDE provider or QSP decides | Subd. 7 |
Two timing rules from the DHS EIDBI manual matter here. Each service authorization request cannot exceed a 180-day span, and the ITP may be signed the same day as the CMDE but not before it. Effective January 1, 2026, Acentra Health reviews CMDEs and ITPs within seven calendar days for fee-for-service requests. The EIDBI documentation guide lists every ITP element.
Compliance note: subd. 6(g) requires written notice before EIDBI services end, and allows up to 30 days of continued service during the transition period. A family that is told services stop tomorrow, with no transition plan, is entitled to ask for the notice and the plan.
The treatment modalities DHS recognizes
Minnesota is unusual in paying for more than one autism treatment approach. Under subd. 13(b), as amended by Laws of Minnesota 2025, 1st Special Session, chapter 9, article 6, effective July 1, 2025, EIDBI treatment must follow the standards of an approved modality, and the modalities are:
| Modality | Recognized in statute |
|---|---|
| Applied behavior analysis (ABA) | Yes |
| Developmental individual-difference relationship-based model (DIR/Floortime) | Yes |
| Early Start Denver Model (ESDM) | Yes |
| Relationship Development Intervention (RDI) | Yes |
| PLAY Project | No, removed effective July 1, 2025 |
| Early Social Interaction (ESI) | No, removed effective July 1, 2025 |
The 2025 amendment also deleted the clause that let the commissioner approve additional modalities. A provider may use one modality or a combination, and must document the qualifications needed for fidelity to each model. Before a service starts, subd. 16 requires the agency to give the family a written description of the modality and the training of the staff who will deliver it.
Where EIDBI is delivered
Subd. 13(g) says intervention may take place across multiple settings. In practice that means the person's home, an EIDBI center or clinic, community settings, and, with the school district's agreement, a school. Travel time is billable under subd. 13(k) when the ITP states why the provider must travel to the person.
Telehealth is covered under subd. 13(l) in the same manner as in-person delivery, but two limits apply as of September 2026. Required monthly observation and direction may be delivered via telehealth for no more than two consecutive months (subd. 16, effective January 1, 2026). And since January 1, 2026, DHS does not allow direct intervention under 97153, 97154, or 0373T to be delivered or billed during homeschool or online school instruction; only caregiver training with the parent present is covered in that time.
Who provides EIDBI: QSP, Level I to III, and the CMDE provider
Every EIDBI service is provided by a qualified EIDBI provider and supervised by a QSP. Subd. 15 sets the qualifications, summarized in the EIDBI provider requirements guide; the roles are:
| Role | Function | Core qualification |
|---|---|---|
| Qualified supervising professional (QSP) | Overall responsibility for treatment planning, staff supervision, progress monitoring, and treatment review | Licensed mental health professional, licensed behavior analyst, or developmental or behavioral pediatrician with 2,000 hours of supervised ASD experience or equivalent graduate coursework; an agency employee |
| Level I | Develops ITPs, delivers observation and direction and family training, directs higher-ratio intervention | 2,000 supervised hours plus a listed degree or certification |
| Level II | Delivers intervention, may develop ITPs and family training | Degree or certification pathways with 1,000 to 4,000 supervised hours |
| Level III | Delivers intervention under supervision | Age 18 or older, Level III training, and a diploma, language, or experience pathway |
| CMDE provider | Completes the evaluation that establishes medical necessity | Physician, APRN, PA, mental health professional, or qualifying clinical trainee with 2,000 hours of ASD experience; need not be affiliated with an agency |
Since January 1, 2026 every QSP must be an EIDBI agency employee, attested on form DHS-7120C, and the agency must provide at least one hour of clinical supervision for every 16 hours of direct treatment per person. The EIDBI QSP requirements guide explains the role in detail.
EIDBI, school services, and private insurance
The most common question is how EIDBI fits with an individualized education program (IEP). The April 11, 2022 joint memo from DHS and the Minnesota Department of Education says the two are designed to work together: special education supports and EIDBI may be provided at the same time, EIDBI will reimburse medically necessary services delivered in a school setting with prior authorization, and the school district has no financial responsibility for EIDBI. Medical Assistance will not authorize EIDBI to provide academic instruction, and districts may set local policies on provider access to school buildings.
Private insurance is a separate track. Minn. Stat. § 62A.3094 requires large-employer health plans to cover diagnosis and medically necessary treatment of ASD for children under 18, and states that it does not limit or reduce Medical Assistance or MinnesotaCare benefits. A child with both commercial coverage and Medical Assistance should have the agency check coordination of benefits before the first authorization request.
The moratorium, revalidation, and what they mean
EIDBI billing runs through CPT 97151 to 97157 and 0373T with the UB modifier, and the EIDBI billing codes guide covers units, the 20% guideline for observation and direction, and authorization. Enrollment status, however, is what changed most in the past year.
DHS paused enrollment of new EIDBI agencies from November 1, 2025 through October 31, 2026. EIDBI agencies are also one of the 13 services in the enrollment freeze that began January 27, 2026 and was extended in July 2026 through January 27, 2027. Enrolled agencies had to apply for provisional licensure under § 245A.142 by May 31, 2026 and complete Minnesota Revalidate 2026, which DHS launched on January 26, 2026 under a corrective action plan with the Centers for Medicare & Medicaid Services. The Minnesota Revalidate guide explains those steps.
For a family, the pool of agencies is fixed for now, individual providers can still join those agencies, and services continue while the agency is revalidated. For a provider, the record behind every claim is more likely to be requested before payment than it was before 2025.
How Trustora helps
Trustora is one platform for EIDBI, ARMHS, 245D, PCA/CFSS, and adult day services, and its EIDBI module follows the sequence in this guide. The CMDE, ITP, and six-month progress monitoring are stored as structured records with the § 256B.0949 elements as required fields, the modality and each provider's level and supervision status are attached to every session, and the claim is built from the session record with the UB modifier and the supervising QSP already populated.
Supervision and observation and direction are logged against the one-hour-per-16-hours and monthly minimums, and the one-click DHS audit binder assembles the full chain for any person and date range when a pre-payment review or site visit asks for it. See the platform overview for the EIDBI workflow.