IMCare (Itasca Medical Care) describes itself as "your local County health plan" for Itasca County residents on Minnesota Health Care Programs. It is one of the eight plans on DHS’s October 2026 EIDBI MCO grid. IMCare publishes forms and a utilization-management criteria summary but no EIDBI-specific policy, so most plan-level details on this page are things to confirm by phone; the statutory EIDBI rules apply regardless.
DHS’s October 2026 EIDBI MCO grid is the most specific public source for IMCare: member services 218-327-6188 or 800-843-9536; authorizations by fax to 218-327-5545 or secure email to IMCareAuths@co.itasca.mn.us; "No referral requirements"; "Select services require authorization" for contracted providers and "All services require prior authorization for noncontracted providers"; and claims "must be submitted electronically," with two free direct-entry options (MN E-connect from Infotech Global, and Office Ally). The grid also lists an IMCare "EIDBI billing and policy FAQ," which we could not locate on IMCare’s site. IMCare’s utilization-management summary says it relies on DHS criteria, InterQual and its own policies, and allows 90-day transitions for most services when a member arrives from other coverage.[1][4][3][2]
IMCare’s provider appeal sheet: "Enrollees and/or providers must Appeal within 60 days after the date we send a Notice of Action"; IMCare acknowledges within 10 days and decides within 30 days, with up to 14 more if it needs information; the enrollee "may request a State Fair Hearing within 120 days from an IMCare appeal decision."[5]
The questions that decide whether a family can start with IMCare (Itasca Medical Care), 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][15]
IMCare 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.[16][17]
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][15]
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."[15][16]
No. DHS’s October 2026 grid, for IMCare: "No referral requirements."[1]
IMCare 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][18][19]
IMCare publishes no EIDBI decision clock. State and federal law apply: since January 1, 2026 standard determinations are due within five business days of a complete request and expedited ones within 48 hours including a business day (§§ 62M.01, subd. 3(b), 62M.05), inside the federal 7-calendar-day ceiling (42 CFR 438.210(d)).[9][10][11]
Medical Assistance is still the payer of last resort, but EIDBI is "pay and chase." DHS: "EIDBI providers are not required to bill a member’s commercial insurance before billing Medicaid. MHCP or the MCO will seek reimbursement from third parties … This ‘pay and chase’ process applies to both fee-for-service and managed care members," though a payment received from another source must still be reported. That matches the federal rule letting states pay EPSDT claims and recover later (42 CFR 433.139(b)(3)(i)). For authorization, DHS tells providers with privately insured members to "follow the primary insurance’s authorization procedures."[8][12]
Coverage decides whether IMCare (Itasca Medical Care) 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.
IMCare publishes no EIDBI supervision rule of its own. Set by statute for every Medical Assistance member, fee-for-service or managed care. An EIDBI agency must "provide clinical supervision for a minimum of one hour for every 16 hours of direct treatment per person, unless otherwise authorized in the person’s individual treatment plan," and must provide "the required EIDBI intervention observation and direction by a QSP at least once per month" (Minn. Stat. § 256B.0949, subd. 16(a)(15)–(16), as amended by Laws 2026, ch. 95). The QSP may do that monthly observation and direction by telehealth for no more than two consecutive months; the third month must be in person. DHS’s clinical supervision page (updated 9/15/26) adds that each person gets one primary QSP (who signs the ITP), a backup QSP must be available, and a different ratio needs an exception documented in the ITP and approved through service authorization. Every intervention must be "provided by a qualified EIDBI provider and supervised by a QSP" (subd. 13(a)).[6][7][13]
IMCare publishes no EIDBI note rule of its own. 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.[7][14]
Not published by IMCare.[1]
Blocked on: IMCare, 218-327-6188: ask whether it follows DHS’s simultaneous-services rule for 97153 with 97155.
Not published by IMCare.[1]
Blocked on: IMCare, 218-327-6188: ask whether DHS’s EIDBI billing-grid limits apply (the EIDBI billing and policy FAQ listed on DHS’s grid may answer this).
Not published by IMCare.[1]
Blocked on: IMCare, 218-327-6188: confirm POS codes for EIDBI (DHS uses 11, 12, and 02/10 for telehealth).
Not published by IMCare.[1]
Blocked on: IMCare, 218-327-6188: ask whether the rendering provider and supervising QSP must both be on the claim, as DHS requires.
Yes, through the EIDBI benefit for Medical Assistance members under 21 in its service area.
Fax 218-327-5545 or secure email IMCareAuths@co.itasca.mn.us. Noncontracted providers need authorization for every service.
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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