Hennepin Health is one of the eight Medical Assistance plans on DHS’s October 2026 EIDBI grid. Its July 2026 prior-authorization chart has a dedicated EIDBI row with two requirements that go beyond the state’s paperwork: the 1:16 supervision ratio restated as a plan rule, and a new obligation to send QSP notes every three months.
Hennepin Health’s "Prior Authorization Requirements for Medical and Behavioral Health Services: July 2026" lists EIDBI as requiring prior authorization for "Intervention – Individual: Adaptive Behavior (97153UB)," group intervention (97154UB), higher intensity (0373T), observation and direction (97155UB), individual and group family/caregiver training (97156UB, 97157UB) and travel time (H0046UB). It adds: "Providers must deliver one hour of clinical supervision by a Qualified Supervising Professional for every 16 hours of direct treatment unless an exception is authorized in ITP," and, marked as a new requirement effective July 1, 2026, "Providers must submit qualifying supervising professional (QSP) notes or supporting documentation to Hennepin Health every three months for all authorized services. Failure to comply may result in delays or disruptions in payment." Requests use the most current DHS-7109 and go by secure fax to 612-677-6222. Standard pre-service requests are completed "within 5 business days of receipt," urgent ones within 48 hours including one business day.[1][2][4][5]
Hennepin Health has also adopted a "Chronic Condition – No Prior Authorization Expiration" policy (effective January 1, 2026) that can issue an authorization with no end date when a provider asks and the criteria are met (a condition expected to last over a year, among others). The policy is written around medications, equipment and services generally and excludes out-of-network providers; it does not mention EIDBI, whose authorizations the state caps at 180 days, so ask before relying on it.[1][2][4][5]
Hennepin Health takes electronic claims only and denies claims "not submitted within 180 days from the date of service" by a contracted provider; adjustment requests are due 180 days from the paid or denied date. Its general claims page says to "Bill the member’s primary insurance first," but DHS’s EIDBI manual says pay-and-chase "applies to both fee-for-service and managed care members," so ask Hennepin Health how it applies the general rule to EIDBI. Out-of-network providers may get continuity-of-care authorizations for up to 120 days from a member’s eligibility date. Contracting starts online at hennepinhealth.org; Provider Services is 612-596-1036 or 800-647-0550, option 2.[3][2][8][5]
The questions that decide whether a family can start with Hennepin Health, and what they have to bring. Each maps onto something intake should ask on the first call.
Under 21. The statute defines the covered "person" as "an individual under 21 years of age" (§ 256B.0949, subd. 2(q)), and DHS lists "Younger than age 21" among the eligibility criteria.[6][14]
Hennepin Health publishes no rule of its own. No expiry on the diagnosis itself; the clock is the CMDE. DHS says the CMDE "must be completed to initiate services and updated at least once every three years" (or sooner when the condition, diagnosis, family, placement or setting changes), the CMDE provider must complete the direct observation within 60 days of the CMDE date, and to restart services after termination "If the person’s CMDE is more than 36 months old … the person must receive a new CMDE." The annual CMDE for reauthorization is due 30 to 60 days before the current service authorization ends.[15][16]
Set by statute: the diagnosis of ASD or a related condition must be "completed by either (i) a licensed physician, advanced practice registered nurse, or physician assistant, or (ii) a mental health professional," be based on current DSM criteria with direct observation and caregiver information, and meet the standard diagnostic assessment rules of § 245I.10, subd. 6 (§ 256B.0949, subd. 4). DHS’s eligibility page says assessors use the DC:0-5 for children five and younger and the DSM from age six. The CMDE provider (physician, APRN, PA, mental health professional, or qualified clinical trainee with 2,000 hours of ASD experience or equivalent coursework) then confirms medical necessity.[6][14]
No instrument is mandated for EIDBI itself: DHS "strongly encourages providers to use standardized assessment tools" but "does not require specific assessment tools." The exception is a CMDE submitted for other disability or benefit decisions (waiver enrollment, SSI): there DHS requires "A direct observational assessment (e.g., ADOS-2)" and "A structured caregiver interview (e.g., ADI-R)," and says developmental history or non-autism-specific screens alone are "insufficient."[14][15]
No. DHS’s October 2026 grid, for Hennepin Health: "No referral requirements."[5]
Hennepin Health publishes no EIDBI telehealth rule of its own. Yes, for most EIDBI services. The statute says Medical Assistance "covers medically necessary EIDBI services and consultations delivered via telehealth … in the same manner as if the service or consultation was delivered in person" (§ 256B.0949, subd. 13(l)). DHS lists the CMDE (97151), coordinated care conference, family/caregiver training (97156/97157), ITP development and progress monitoring (H0032), individual and group intervention (97153/97154) and observation and direction (97155) as telehealth-eligible; higher-intensity intervention (0373T) "cannot occur via telehealth." Same thresholds, authorization and rates as in person; QSP observation and direction may be remote for at most two consecutive months. Bill POS 02 (not at home) or POS 10 (at home), modifier 93 for audio-only, and never use telehealth POS or modifiers for non-client-facing services. Providers enroll for telehealth on the Telehealth Provider Assurance Statement (DHS-6806).[6][17][18]
"Standard service requests submitted on a pre-service or concurrent basis are reviewed and completed within 5 business days of receipt"; requests for services that have ended take 30 calendar days; urgent requests "within 48 hours including one business day."[2]
Conflicting sources. Hennepin Health’s claims page says to "Bill the member’s primary insurance first"; DHS’s EIDBI manual says providers need not bill commercial insurance first and that pay-and-chase "applies to both fee-for-service and managed care members."[3][8]
Ask the plan: Hennepin Health Provider Services, 800-647-0550 option 2: ask whether EIDBI claims need a primary EOB.
Coverage decides whether Hennepin Health pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
Hennepin Health: "one hour of clinical supervision by a Qualified Supervising Professional for every 16 hours of direct treatment unless an exception is authorized in ITP," plus QSP notes every three months (from July 1, 2026). The statute adds monthly QSP observation and direction, no more than two consecutive months by telehealth (§ 256B.0949, subd. 16(a)(15)–(16)).[1][6][7]
Hennepin Health requires QSP notes or supporting documentation every three months. Statutory since 2026. New subdivision 19 of § 256B.0949 (Laws 2026, ch. 95, art. 4, sec. 26) requires all CMDE and EIDBI documentation to be "signed and dated by the provider completing the documentation with the provider’s full name, title, and credentials," to "be entered within 72 hours of service and contain a record and explanation of any delays in entry," and to "include a record of supervision and oversight for staff providing services requiring supervision." "Each EIDBI service occurrence must be documented in a progress note." DHS-7108 (CMDE) must be signed by the CMDE provider and the caregiver or guardian, and DHS-7109 (ITP) by the QSP and the caregiver or guardian; those signatures are the family’s consent to start or continue services.[1][7]
Not addressed by Hennepin Health.[1]
Ask the plan: Hennepin Health Provider Services, 800-647-0550 option 2: ask whether 97153 and 97155 by different staff may be billed for the same time, as DHS allows.
Hennepin Health publishes no EIDBI unit limits of its own.[1]
Ask the plan: Hennepin Health Provider Services, 800-647-0550 option 2: ask whether DHS’s EIDBI billing-grid daily limits apply.
Hennepin Health publishes no EIDBI setting rule.[1]
Ask the plan: Hennepin Health Provider Services: confirm accepted POS codes (DHS uses POS 11 and 12, POS 02/10 for telehealth).
Hennepin Health’s claims page requires the ordering or referring provider’s NPI or UMPI "if applicable" but states no EIDBI rendering/supervising rule.[3]
Ask the plan: Hennepin Health Provider Services: ask whether the rendering provider and supervising QSP must both appear on EIDBI claims, as DHS requires.
Yes for 97153, 97154, 0373T, 97155, 97156, 97157 and H0046 (UB modifier). Fax the request with the current DHS-7109 to 612-677-6222.
Providers must send QSP notes or supporting documentation every three months for all authorized EIDBI services; missing them can delay payment.
Five business days for standard pre-service requests, 48 hours for urgent ones.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.
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