---
title: "Medica One Health Plan (formerly UCare) ABA / EIDBI coverage: the intake guide."
url: "https://carelu.com/payers/medica-one-health-plan-minnesota"
markdown_url: "https://carelu.com/payers/medica-one-health-plan-minnesota.md"
state: MN (Minnesota)
payer: Medica One Health Plan (formerly UCare Medical Assistance)
kind: Medicaid managed care plan (MCO)
parent_program: Minnesota Medical Assistance (EIDBI benefit, managed care)
description: "How Medica One Health Plan, the former UCare Medical Assistance plans now run by Medica, handles ABA under the EIDBI benefit: the October 2026 transition, Optum contacts, authorization by fax, and what intake should confirm."
last_reviewed: October 2026
---

# Medica One Health Plan (formerly UCare) ABA / EIDBI coverage: the intake guide.

_Payer Guide · Medica One Health Plan · Minnesota · Last updated October 2026 · 12 primary sources_

> The former UCare Medical Assistance plans, under Medica since Oct. 1, 2026; EIDBI through Optum with the same fax as Medica.

UCare was placed into court-supervised rehabilitation in December 2025, and Medica acquired its Medical Assistance contracts. DHS said UCare’s PMAP, MinnesotaCare, MSC+ and SNBC products would continue under the UCare name from January 1, 2026; UCare’s closure FAQ now says "UCare Medical Assistance (Medicaid) plans are now known as Medica One Health Plan. These plans transitioned to Medica on Oct. 1, 2026." DHS’s October 2026 EIDBI grid lists Medica One Health Plan as its own column, administered through Optum like Medica.

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: Medica One Health Plan Member or Provider Services, 800-850-6141: ask whether 97151 UB needs authorization. [3]
- **Prior auth for treatment**: "Select services require authorization. Fax ITP and CMDE requests to: 855-454-8155"; noncontracted providers need prior authorization for all services (DHS grid) [3]
- **Autism diagnosis required?**: Yes: the statutory 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) [5][3]

## At a glance

- **Covers ABA?:** Yes, as EIDBI for members under 21
- **Plan history:** UCare Medical Assistance until Sept. 30, 2026; Medica One Health Plan from Oct. 1, 2026
- **Prior auth:** Select services; fax ITP and CMDE to 855-454-8155
- **Contact:** Member or Provider Services 800-850-6141
- **Network:** Optum Provider Services 877-614-0484; providerexpress.com
- **Referral:** None required (DHS grid)

## The UCare transition and what it means for authorizations

DHS’s December 18, 2025 bulletin said Medica was acquiring certain UCare contracts, that UCare’s PMAP, MinnesotaCare, MSC+ and SNBC products "are not impacted" and would continue under the UCare name from January 1, 2026, and that "Medica commits to providing advance notice of any future changes." UCare’s FAQ records the next step: the Medical Assistance plans became Medica One Health Plan on October 1, 2026, and UCare remains in court-supervised rehabilitation, whose plan changed some claim-filing and appeal deadlines for older UCare claims ("2026 claims are not impacted"). DHS’s rules on changing MCOs also say a new plan "Must provide members medically necessary covered services that another MCO or MHCP FFS had authorized before enrollment," which protects existing EIDBI authorizations through a plan change. [1][2][4][3]

For EIDBI the October 2026 DHS grid gives Medica One Health Plan the same behavioral-health fax as Medica (855-454-8155, "Fax ITP and CMDE requests"), "No referral requirements," authorization of all services for noncontracted providers, Member or Provider Services at 800-850-6141, and network contracting through Optum Provider Services (877-614-0484). No EIDBI policy specific to Medica One Health Plan is published. [1][2][4][3]

## Intake gates

The questions that decide whether a family can start with Medica One Health Plan (formerly UCare Medical Assistance), 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. [5][15]
- **Diagnosis recency**: No plan-specific rule is published. 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. [5][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 Medica One Health Plan: "No referral requirements." [3]
- **Telehealth**: No plan-specific EIDBI telehealth rule is published. 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). [5][18][19]
- **Prior-auth decision time**: No plan-specific clock is published. 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 (§§ 62M.01, subd. 3(b), 62M.05), inside the federal 7-calendar-day ceiling (42 CFR 438.210(d)). [8][9][10]
- **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." [7][11]

## Delivery and billing rules

Coverage decides whether Medica One Health Plan (formerly UCare Medical Assistance) 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**: No plan-specific EIDBI supervision rule is published. 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)). [5][6][13]
- **Session-note signature**: No plan-specific note rule is published. 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. [6][14]
- **Concurrent billing (97153 + 97155):** Not published / unverified. Verify via: Medica One Health Plan Provider Services, 800-850-6141. [3]

## What intake should collect for Medica One Health Plan (formerly UCare Medical Assistance)

- **Member ID card:** Former UCare members carry Medica One Health Plan cards from Oct. 1, 2026; confirm the plan in MN–ITS.
- **Existing authorization:** Capture any UCare EIDBI authorization; a new plan must honor prior authorizations.
- **CMDE and ITP:** Fax both to 855-454-8155.

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

## Common questions

### What happened to UCare Medical Assistance?

UCare’s Medical Assistance plans moved to Medica and became Medica One Health Plan on October 1, 2026. UCare itself is in court-supervised rehabilitation.

### Does an existing UCare EIDBI authorization carry over?

DHS requires a plan to provide medically necessary services that a previous MCO or fee-for-service had authorized before enrollment. Send the new plan the current authorization, CMDE and ITP and confirm.

## Primary sources

1. [DHS MHCP provider bulletin — Medica acquiring UCare clarifications (Dec. 18, 2025)](https://content.govdelivery.com/accounts/MNDHS/bulletins/400969b)
2. [UCare — Plan closure FAQ (UCare Medical Assistance plans now Medica One Health Plan, Oct. 1, 2026)](https://www.ucare.org/about-us/plan-closure-faq)
3. [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)
4. [MHCP Provider Manual — Managed Care Organizations (carve-outs, MCO and state appeal rights)](https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=id_008923)
5. [Minn. Stat. § 256B.0949 — Early Intensive Developmental and Behavioral Intervention (EIDBI) benefit](https://www.revisor.mn.gov/statutes/cite/256B.0949)
6. [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/)
7. [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)
8. [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)
9. [Minn. Stat. § 62M.05 — Review determinations: standard 5 business days, expedited 48 hours](https://www.revisor.mn.gov/statutes/cite/62M.05)
10. [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)
11. [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)
12. [Medica — News for Providers (Connections monthly newsletter archive)](https://partner.medica.com/providers/news)
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.