Assessment and Planning for EIDBI

Admission Forms

Prior to initiating services and annnually thereafter, explain the EIDBI service, including what will be required of parents. Complete and obtain the parent's or guardian's signature on these forms:

Document that each of these forms has been signed and filed in Tabs using the EIDBI Required Forms Record found in Document > Client Forms > Authorizations, Consents and Releases.

Before providing direct services, obtain the parent's or guardian's signature on these forms (these are also required for obtaining prior-authorization):

The following Scheduling Request form is for use in informing parents of their rights and responsibilities for scheduling services, and for requesting schedules or changes in schedules.

The CMDE

EIDBI services begin with a Comprehensive Multi-Disciplinary Evaluation, or CMDE. During the CMDE, a Qualified Evaluator:

• gathers and summarizes medical or assessment information from medical specialists, rehabilitation or habilitation therapists, licensed school personnel, and mental health professionals, family members, school personnel, childcare providers or other caregivers;
• completes a structured observation of the person
• administers standardized tests or assessment tools where they are applicable;
• interviews parents or primary caregivers and documents their preferences for involvement in the person’s treatment;
• determines whether or not EIDBI interventions are medically necessary; and if so
• makes treatment recommendations;
• requests prior authorization for interventions from Medical Assistance or the Managed Care Provider using the DHS-7108 (PDF) form; and
• documents the CMDE in the CMDE Summary in Tabs^TM.

Prior Authorization Required

EIDBI interventions must be prior-authorized. Following the CMDE, we must develop an Individualized Treatment Plan, and submit that for approval as well. 

Follow the links below for DHS instructions for:

• >Completing the CMDE
• >Completing the DHS-7108 form

Tabs Forms That Must Be Completed Prior to Starting EIDBI Intervention Services

The following Tabs forms must all be in approved status prior to starting intervention services:

• Diagnostic Assessment (internal or review of external);
• CMDE
• EIDBI Intake and CMDE Checklist; or
• CMDE Quick Add;
• EIDBI Treatment Plan Authorization (found in Intake, Admission, Consents, ROI); and
• Tabs Treatment Plan.

The Individual Treatment Plan

The Qualified Supervising Professional completes the Individualized Treatment Plan with contributions from Level I and Level II Providers and based on the recommendations in the CMDE. No prior authorization is required to develop the first ITP, but approval of the ITP is required prior to initiating the services in it.

Developing and obtaining approval for the ITP includes these two steps:

• Write goals and objectives in Tabs^TM and build the plan.
• Using outome statements developed in Tabs^TM, complete the required DHS-7109 (PDF) form and submit it for approval.
• Submit any additional prior-authorization requests required by the Managed Care Organization, if applicable.
• Upload all documents used for prior authorization to Tabs^TM.

EIDBI Goals and Objectives

Develop EIDBI goals and objectives with the person, and/or with his or her parent or guardian and primary caregiver. Goals may be phrased broadly and should be stated positively (e.g., Make friends, Learn communication skills, Achieve developmental milestones, Improve motor skills, etc.)

Objectives in EIDBI are specific and tangible, describing in outcome statements how the individual will demonstrate progress toward the overall goal. Read more about writing treatment objectives and measurable outcome statements in the Treatment/Service Planning section of this guide.

The Coordinated Care Conference

The Coordinated Care Conference is a meeting between the person, his or her family, EIDBI provider(s), other service professionals and/or other individuals the person/family requests. The Initial conference should occur after the Goals and Objectives for each ITP and update are drafted.

The purpose of the initial Coordinated Care Conference is to finalize the ITP and make arrangements for service delivery and coordination. During the initial coordinated care conference, the participants:

• review the CMDE results, including treatment options, parent/primary caregiver preferences and provider recommendations;
• discuss the parent or primary caregiver’s preferences for treatment modality, scope, intensity, frequency and duration, days, times and locations for services;
• develop and coordinate the implementation of the person’s individual treatment plan and assign roles to each provider;
• identify how the parent or primary caregiver will be involved in the person’s treatment;
• make plans to coordinate EIDBI services with other services the person and family receives;
• refer the person or family for other services, if needed; and
• finalize the Treatment Plan.

Billing for the Coordinated Care Conference

A Coordinated Care Conference may be billed on the same day that other EIDBI service were provided.

Multiple providers my bill for the Coordinated Care Conference, but only one of each provider type. This includes the CMDE provider, the Qualified Supervising Professional, and Level I and II providers who are serving the individual. Document your participation according to the documentation instructions below.

Any of the following MHCP-enrolled EIDBI providers may participate in and bill for the coordinated care conference. It is not a requirement that the CMDE provider or QSP attend.

• CMDE providers
• QSP
• Level I
• Level II

Update Coordinated Care Conferences

An Update Coordinated Care Conference is recommended with each update to the ITP. In an Update Coordinated Care Conference, the participants:

• review progress on the current plan;
• review significant changes in functioning or behavior;
• review significant changes in status or life circumstances (new school, new home, change in caregiver, etc);.
• document decisions about changes in the ITP;
• discuss other service updates, as applicable;
• identify any additional efforts that may be necessary to coordinate EIDBI services with other services the person and family receives;
• refer the person or family for other services, if needed; and
• discuss transition and discharge planning.

Service Delivery & Coordination

Level I and II Direct Interventions

Direct interventions are provided by Level I and Level II EIDBI practitioners. These interventions are desribed in the Treatment Plan. All direct services provided under this service type must be formal, following the techniques and methods, and teaching the skills defined in the Individual Treatment Plan.

You will collect data throughout each treatment session, sometimes on worksheets that accompany the plan and summarize final results under each desired outcome in Tabs^TM, during each session, according to the methods in the plan.

Family/Caregiver Counseling and Training

When Family Counseling and Training Might Be Needed

Family Counseling and Training may be very necessary:

• In every case where families need help understanding the child's condition, available support resources, the treatment plan, and developing strategies to interact with and respond to the child's behavior consistent with the plan
• When families are having a hard time developing a consistent home routine
• When families are cancelling, not attending appointments, or arriving late because they have not been able to develop a routine
• When families are expressing difficulty trying to implement interventions to teach skills and redirect behavior
• When families are struggling with advocating on behalf of their child with health care, education, and other service providers

The purpose of family/caregiver training and counseling are as follows.

1. Help families and caregivers support the person’s development by learning:
• about the person’s condition;
• about other resources available to support the person and their family, and how to access them;
• about the treatment plan, and how families and caregivers can help the person generalize skills learned in treatment, and positively impact treatment outcomes; and
• how to use specialized behavioral and developmental techniques and strategies to reduce challenging behaviors and reinforce or increase appropriate behaviors and skills.
2. Build family and caregivers’ competence and resilience.
3. Promote the person and family’s participation in home, school and community.

Family Counseling and Training is Part of the Individual Treatment Plan

Family Counseling and Training should be formal, using approved resources, with knowledge and skills. Build objectives for Family/Caregiver Counseling and Training into the Treatment Plan by writing learning outcomes that describe knowledge elements and skills parents and caregivers will master to support the child or young adult.

These objectives should be linked to the direct (Individual Intervention) objectives, showing how caregivers  will support the plan and the individual's development.

Observation and Direction

Observation and Direction consists of a QSP, Level I or Level II provider who has been trained and approved to do so, providing Observaion and Direction to another Level I or Level II provider. Observation and direction may only be billed when observing services by a provider of the same or lower level: QSP > Level I, Level I > Level I or Level II, Level II > Level II or Level III).

According to the EIDBI Policy Manual:

"Intervention observation and direction is provided for the direct benefit of the person based on his/her needs. The purpose of the service is to ensure treatment fidelity and integrity, as well as to inform any necessary treatment or program modifications. It provides face-to-face, real-time direction to a provider to maximize the effectiveness of:

• Data collection
• Generalization of newly acquired skills
• Individual treatment plan (ITP) implementation
• Progress measurement
• Training or refining treatment techniques and strategies
• Understanding or determining the function of behaviors.

"Level I, II and III home-based EIDBI providers might need regular observation and direction until they can competently and independently implement the person’s treatment strategies."

Especially when someone is in training to provide observaion and direction services, but also at regular intervals to assure quality, more than one provider may bill observation and direction simultaneously during an intervention service. (For example QSP or Level I observing and directing a Level II, who is in turn observing and directing a Level II or Level III provider who is providing intervention services.

All providers should receive observation and direction with all recipients early in the treatment process (first or second session with any given recipient), and at at regular intervals thereafter to assure quality.

EIDBI Services By Telemedicine

Check back the week of April 6, 2020 for further guidance here.

EIDBI Services While Traveling

In some other services, intervention while traveling may be allowed by our Travel During Services policy.. EIDBI services are generally not apppropriately provided while traveling, except as described below.

Billing services of any kind while traveling, when the sole purpose of the travel is transportation of the recipient is an Accend and MHCP programs policy violation.

EIDBI Intervention

EIDIB Intervention is allowed while traveling only when all of the following conditions are met:

• The child is present in the vehicle.
• The Intervention is by an EIDBI provider who is a passenger in the vehicle (never by the driver of the vehicle)
• When the intervention is focused on teaching skills that are safely and appropriately taught in a vehicle, such as automobile safety, communication, behavior, etc.
• The travel otherwise adheres to our Travel During Services policy.

The above also applies to Observation and Direction of EIDBI services.

Family and Caregiver Counseling and Training

Family and Caregiver Counseling and Training may be appropriate while traveling, when the provider is the driver, so long the service adheres to our Travel During Services policy, can be provided safely and appropriately, and is not for the sole purpose of transporting the parent or caregiver.

Use of Restraints or Seclusion

Accend strictly prohibits use of restraints to only situations where restraint is necesary to prevent serious harm. Seclustion techniques are not allowed. Read our policy on Positive Behavioral Redirection, De-Escalation and Intervention now. Then hit the back button in your browser to return to this page.

Incident Reporting

See the definitions of reportable incidents in our Advanced Guide: Accidents, Incidents and Sentinel Events now. When you complete an incident report during provision of EIDBI services, identify this by using the add-on to your progress note: Incident Report Filed. Contact your Team Leader or Program Director to review the reporty.

All reportable incidents (including Involuntary Restraints) occuring during provision of EIDBI services must be reviewed by the Qualified Supervising Professional. Supervisors conduting the initial review should send the report to the Clinical Supervisor for final review and approval of the report.

Documenting EIDBI Services

You will collect data throughout each treatment session, sometimes on worksheets that accompany the plan. You will then summarize final results under each desired outcome in Tabs^TM, following each session, according to the methods in the plan.

Note Type Summary

Document delivery of EIDBI services in Tabs^TM using these service types:

Billable EIDBI Services

Activity	Service Type & Special Instructions
Conducting the Comprehensive Multi-Disciplinary Evaluation. This includes interviewing, observing, reviewing medical records to inform the CMDE, writing results and findings.	Comp MultiDisciplinary Evaluation Document start and end time.
Gathering information, conducting interviews, reviewing the recommendations of the CMDE, writing goals and objectives for developing the treatment plan. Reviewing progress and updating the plan. See specific guidance for this below.	ITP Development and Monitoring by QSP ITP Development and Monitoring by LI or LII
Facilitating or attending the Coordinated Care Conference.	Coordinated Care Conference by MHP Coordinated Care Conference by QSP Coordinated Care Conference by LI, LII, or LIII Only one provider of each type may bill for the Coordinated Care Conference. If more than one (LI, LII, etc.) will attend, with prior authorization, the second provider should document Other Prior-Authorized Client Services.
Providing specialized training, education and support for a person’s family or caregiver.	Family Counseling and Training by QSP Family Counseling and Training by LI, LII, or LIII
Direct services implementing the Treatment Plan	EIBDI Individual Level I, Level II, or Level III
Direction and observation by a qualified EIDBI provider to a lower-level EIDBI provider who is delivering individual intervention services. QSP to Level I, Level I to Level II. Observation and Direction "must include the physical presence of the person and/or his/her parent or primary caregiver in the person’s home or center." In other words, debriefing time after the direct interventionservice ends cannot be billed as Observation and Direction unless it includes the presence of a primary caregiver.	Observation and Direction by QSP Observation and Direction by Level I, or Level II

Other Add-Ons to Progress Notes

Add-On	Use When
Involuntary Hold Report Filed	You implement an involuntary hold per policy and file a report.
Successful De-Escalation	In your judgement, you averted the use of an involuntary hold with successful non-invasive de-escalation or redirection. Follow your best judgement for when to use this add-on, but do not overuse it.
Incident Report Filed	When an incident occurs that complies with the defintion of reportable incidents in that policy, and you file and incident report, flag your progress note with this add-on.
Being Observed During Services	Add this to any service (Intervention, Family Counseling and Training, or Observation & Direction) when you are yourself being observed. Make sure that the time matches that documented by the person doing the Observation and Direction.

Non-Billable EIDBI Support and Coordination Activities

Use the following sparingly, and only when activities do not fit the definition of billable services above.

Activity	Description
CMDE Support	Gathering and entering data and information to support the CMDE provider in completing the CMDE.
EIDBI Cancellation by Provider	Use when you have a scheduled service and you cancel it (call in sick or other reasons), or when we cancel it for weather or other emergencies. Simply change the service type.
EIDBI Client-Initiated Cancellation	Use when you have a scheduled service and the client or parent cancels or no-shows. Simply change the service type.
EIDBI Contact and Scheduling	Use when contacting clients or parents to schedule or reschedule a session.
EIDBI Intervention Support	Use when stepping in to support a coworker with a child as a behavioral intervention or other.
EIDBI Service Coordination	Use when coordinating EIDBI services with other services provided to the child, internally or externally. Internally only when the activity does not fit the definition of ITP Development and and Review, or Treatment Supervision of another service provided to the child.
EIDBI Treatment Resource Development	Use when reviewing or developing Treatment Resources for EIDBI.
Open for EDBI	Use to indicate your availability to be scheduled for EIDBI Intervention or Observation and Direction services.

For more information about objective and professional documentation standards for Progress Notes, see the Progress Notes section of this guide.

ITP Development and Monitoring Guidelines

What is Billable IPT Development and Monitoring Work?

ITP Development and Monitoring is a service billed to develop the ITP, collect baseline data, and review and monitor progress

Activities that can be documented as ITP Development and Monitoring include:

• Development of ITP objectives
• Meeting with parents to gather initial ITP information
• Meeting with parents to review progress of ITP objectives
• Inputting information into the eDocs form (data entry, addendums, etc)
• Gathering/creating individualized baseline testing materials for the development of new objectives
• Gathering data for FBAs, developing/writing up the FBA
• Collecting baseline data
• Updating individualized data sheets/graphs based on progress monitoring
• Monthly progress reviews

Each note should include:

• Specific data/domains targeted: Which domains baseline data was collected on, or which domains materials were for; what the data show
• Scope of service (e.g., treatment modalities used, who was involved, information provided to caregiver, etc.)

Examples of activities that cannot be billed as ITP development and monitoring:

• Coordinated Care Conference (its own service)
• IEP Meetings (unless ITP progress, or coordination of ITP objectives and IEP goals are discussed)
• Parent Meetings unrelated to child progress
• Making non-specific client materials
• Making/gathering materials that will not be used in baseline data collection
• Working on the CMDE
• Gathering baseline data at the same time as someone is billing a direct service (CTSS or EIDBI); other than observational FBA data
• Non-billable examples:
• “I made a binder for Sarah”
• “I laminated materials”
• Transcribing data versus modifying ojectives, outcomes

Time Guidelines

ITP Development and Monitoring are activities directly associated with observation, interview, assessment (such as FBA), crafting treatment objectives, analyzing data collected for progress review and plan updates, and other activities directly associated with Treatment Plan Development and Progress Review.

ITP Development and Monitoring is billed per occurence (session) and paid per hour. Meaningful ITP Development and Monitoring sessions should last 15-90 minutes.

General guidelines for for ITP Development and Monitoring are described in the table below. Seek authorization for all ITP Development and Monitoring activites from the lead Behavior Analyst for the recipient.

Activity	Time Limit Guidelines	Consists of the Following Activities
Inital Plan Development	Up to 60 sessions and no more that necessary to develop the initial plan	Direct observation of the child/young adult recipient Interviews with the recipient and the recipient's caregivers or family members, teachers and other professionals Conducting Functional Behavior Life Skills inventories and other assessments, and reviewing recommendations from the CMDE Gathering baseline data (through direct observation) for use in treatment objectives Analyzing data collected in observation sessions Crafting goals and objectives for the initial treatment plan
First month of initial plan implementation	Up to 6 Sessions	Analyzing data provided by providers implementing the plan and Observing/Directing implementation Verifying baseline data collected during initial plan development Quality assurance interviews with the recipient, caregivers and family members Other activities directed at assuring the quality of the treatment plan and consistency of implementation
Months 2-4 of plan implementation	1-2 sessions/month	Summarizing and analyzng progress data collected during the month in the Progress Review document
2 months leading up to plan end/update	Up to 6 sessions/month	Analyzng progress data collected during Progress Reviews to inform recommendations for continuation of services or discharge Interviews with the recipient and the recipient's caregivers or family members, teachers and other professionals Conducting additional or updating Functional Behavior Life Skills inventories and other assessments Analyzing data collected in observation sessions Crafting goals and objectives for an update to the treatment plan
Early plan revision	Up to 6 sessions in the month of the revision	Analyzng progress data collected during Progress Reviews to inform recommendations for plan modification Interviews with the recipient and the recipient's caregivers or family members, teachers and other professionals Conducting additional or updating Functional Behavior Life Skills inventories and other assessments Analyzing data collected in observation sessions Crafting goals and objectives for an revision to the treatment plan

Progress Review & Quality Assurance

Progress review and quality assurance in EIDBI services centers on progress toward the tangible and objectively measurable outcomes articulated in the Individual Treatment Plan. This is an ongoing process that includes monthly reviews of data. If, during monthly review, it appears that the plan may not be having results, a change in the plan, the targeted outcomes, or the methods and techniques may be in order.

Level I providers who provide observation and direction, or the QSP complete the monthly review.

Discharge Planning

Termination of EIDBI services may be determined medically necessary for one or more of the following reasons, as defined by the DHS EIDBI policy manual:

1. The person has achieved maximum benefit from EIDBI services, as documented by measurable progress on and generalization of goals and objectives across environments and people.
2. The person no longer meets medical necessity criteria for EIDBI services.
3. EIDBI services make the person’s symptoms persistently worse.
4. The person is not making progress toward individual treatment goals. (This lack of progress is demonstrated by the absence of any documented, sustainable, generalized and measurable progress.)
5. The person has not shown signs of or the provider does not reasonably expect the person to show signs of measurable progress within 12 months of the initial ITP development. This is demonstrated by both:
• a lack of documented progress during the ITP update; and
• adjustments to the treatment plan that haven’t benefited the person.
6. The parent/ or legal guardian requests termination of services.
7. The CMDE provider or QSP recommends a termination of services because the person would likely benefit from another service or be more appropriately served by less-intensive forms of treatment.

Discharge Procedures

Regardless of the reason for discharge, follow these steps:

Complete a progress review summarizing progress in treatment to date.

If the decision to discharge is involuntary, inform the individual or parent/guardian in a letter of the reasons for discharge and inform them that they may appeal the decision. Obtain their signature and their preferences for appealing the discharge decision in the letter and put it in the individual's Tabs^TM documents file.

Involuntary discharge occurs when or example based on a determination that EIBDI services are no longer medically necessary, ineffective or harmful, or that discharge is appropriate for other reasons listed above but the individual or parent guardian does not want to discharge.

Resources & References

EIDBI Team Member Credentials

Tap on the links below to read the qualifications for each provider type.

• > CMDE Evaluator
• > Qualified Supervising Professional
• > Level I EIDBI Provider
• > Level II EIDBI Provider

DHS Guidance Manuals

Tap on the links below to read guidance from the Minnesota Department of Human Resources

• >EIDBI Policy Manual Page
• >MHCP Manual EIDBI Page
• >DHS EIDBI Benefit Page
• >EIDBI Advisory Group Page

Feedback or Questions about this Chapter

This guide is a living document. We want to improve it with your help. Do you have questions? Found a typo? Find yourself wanting more information? Please send us your thoughts about anything in this chapter by tapping on the link below.

Updates to this Chapter

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November 30, 2022:

Coordinated Care Conference pariticipants clarified and clarification that the CMDE provider and QSP are not mandated to attend.

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April 5, 2023:

Non-Billable EIDBI note types added and described.

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August 23, 2023:

Coordinated Care Conference billing rules clarified that EIDBI serivices can take place the same day as Coordinated Care Conference.

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Coming soon:

Additional Add-On type descriptions to match the options in Tabs.

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