---
title: "IMCare (Itasca Medical Care) ABA / EIDBI coverage: the intake guide."
url: "https://carelu.com/payers/imcare-minnesota"
markdown_url: "https://carelu.com/payers/imcare-minnesota.md"
state: MN (Minnesota)
payer: IMCare (Itasca Medical Care)
kind: Medicaid managed care plan (MCO)
parent_program: Minnesota Medical Assistance (EIDBI benefit, managed care)
description: "How IMCare, Itasca County’s Medical Assistance plan, handles ABA under the EIDBI benefit: authorization contacts, what the state rules guarantee, appeal deadlines, and the plan-specific facts to confirm by phone."
last_reviewed: October 2026
---

# IMCare (Itasca Medical Care) ABA / EIDBI coverage: the intake guide.

_Payer Guide · IMCare · Minnesota · Last updated October 2026 · 12 primary sources_

> Itasca County’s local county health plan: EIDBI authorized by fax or secure email; most plan-specific EIDBI rules are unpublished.

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.

This plan administers the **Minnesota Medical Assistance (EIDBI benefit, managed care)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [Minnesota Medical Assistance (EIDBI) guide](https://carelu.com/payers/minnesota-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment:** Not published / unverified. Verify via: IMCare Member/Provider Services, 218-327-6188 or 800-843-9536: ask whether 97151 UB (CMDE) needs authorization. [1][3]
- **Prior auth for treatment:** Not published / unverified. Verify via: IMCare, 218-327-6188 or 800-843-9536 (fax 218-327-5545, IMCareAuths@co.itasca.mn.us): ask which EIDBI codes need authorization. [1]
- **Autism diagnosis required?**: Yes: the statutory EIDBI rule binds every Medical Assistance plan: ASD or a related condition diagnosed by a physician, APRN, PA or mental health professional (§ 256B.0949, subd. 4). IMCare publishes nothing different [6][3]

## At a glance

- **Covers ABA?:** Yes, as EIDBI for members under 21
- **Prior auth:** Select services (contracted); all services (noncontracted)
- **Submit via:** Fax 218-327-5545 or secure email IMCareAuths@co.itasca.mn.us
- **Referral:** None required (DHS grid)
- **Claims:** Electronic only; free MN E-connect or Office Ally submission
- **Appeals:** 60 days to appeal; state fair hearing within 120 days of IMCare’s decision

## What IMCare publishes

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]

## Appeals

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]

## Intake gates

The questions that decide whether a family can start with IMCare (Itasca Medical Care), and what they have to bring.

- **Age limit**: 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]
- **Diagnosis recency**: 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]
- **Who may diagnose**: 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]
- **Diagnostic tools required**: 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]
- **Referral required?**: No. DHS’s October 2026 grid, for IMCare: "No referral requirements." [1]
- **Telehealth**: 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]
- **Prior-auth decision time**: 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]
- **Other insurance (who pays first)**: 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]

## Delivery and billing rules

Coverage decides whether IMCare (Itasca Medical Care) pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision**: 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]
- **Session-note signature**: 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]
- **Concurrent billing (97153 + 97155):** Not published / unverified. Verify via: IMCare, 218-327-6188: ask whether it follows DHS’s simultaneous-services rule for 97153 with 97155. [1]

## What intake should collect for IMCare (Itasca Medical Care)

- **Member ID:** Confirm IMCare enrollment (Itasca County service area) on the date of service.
- **CMDE and ITP:** Have both ready; ask IMCare which codes it authorizes.
- **Network status:** Noncontracted providers need authorization for every service.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Common questions

### Does IMCare cover ABA?

Yes, through the EIDBI benefit for Medical Assistance members under 21 in its service area.

### How do I send an EIDBI authorization to IMCare?

Fax 218-327-5545 or secure email IMCareAuths@co.itasca.mn.us. Noncontracted providers need authorization for every service.

## Primary sources

1. [DHS — EIDBI Managed Care Organization (MCO) Contact Information Grid (October 2026)](https://www.dhs.state.mn.us/main/groups/manuals/documents/pub/DHS-312255.pdf)
2. [IMCare (Itasca Medical Care) home page — "your local County health plan"](http://imcare.org/)
3. [IMCare — Providers & Partners (forms, provider portal)](https://www.itascacountymn.gov/357/Providers-Partners)
4. [IMCare — 2025 Utilization Management Medical-Necessity Criteria](https://www.itascacountymn.gov/DocumentCenter/View/11795/2025-Utilization-Management-Criteria-PDF)
5. [IMCare (Itasca Medical Care) — Provider Appeal and Grievance Information](https://www.itascacountymn.gov/DocumentCenter/View/4581/Provider-Appeal-and-Grievance-Information-PDF)
6. [Minn. Stat. § 256B.0949 — Early Intensive Developmental and Behavioral Intervention (EIDBI) benefit](https://www.revisor.mn.gov/statutes/cite/256B.0949)
7. [Laws 2026, ch. 95, art. 4, secs. 23–26 — EIDBI definitions, QSP observation and direction, new documentation subdivision 19](https://www.revisor.mn.gov/laws/2026/0/Session+Law/Chapter/95/)
8. [MHCP Provider Manual — Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit (revised Sept. 14, 2026)](https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=DHS16_195658)
9. [Minn. Stat. § 62M.01 — Utilization Review Act scope (applies to MA managed care and, for listed sections, MA fee-for-service from Jan. 1, 2026)](https://www.revisor.mn.gov/statutes/cite/62M.01)
10. [Minn. Stat. § 62M.05 — Review determinations: standard 5 business days, expedited 48 hours](https://www.revisor.mn.gov/statutes/cite/62M.05)
11. [42 CFR 438.210(d) — Medicaid managed care authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-D/section-438.210)
12. [42 CFR 433.139 — Medicaid third-party liability, incl. pay-and-recover for EPSDT (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)
13. [EIDBI Benefit Policy Manual — Clinical supervision (updated 9/15/26)](https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_195399)
14. [EIDBI Benefit Policy Manual — EIDBI services (updated 1/6/26)](https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_195211)
15. [EIDBI Benefit Policy Manual — Eligibility for EIDBI services](https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_195213)
16. [EIDBI Benefit Policy Manual — Comprehensive multi-disciplinary evaluation (CMDE) (updated 11/7/25)](https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_195210)
17. [EIDBI Benefit Policy Manual — Medical necessity criteria](https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_195405)
18. [EIDBI Benefit Policy Manual — Telehealth services (updated 9/10/26)](https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=DHS-292812)
19. [MHCP Provider Manual — Telehealth Services (POS 02/10, modifier 93)](https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=DHS-335178)

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.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.