Monthly Archives: June 2022

Comments Off on Minnesota Health Plans Continue Business as usual – Separate and Unequal

Alright – so, where do I even start with this blog. My head is spinning. If you follow my blog or know me then you understand my love/hate, ok mostly hate with Minnesota health plans. Let’s explain a bit to anyone new to this blog. Over a decade ago, there was a black boy with autism who was denied autism therapy (ABA) by Health Partners. This child had Medicaid via Health Partners. In parallel, the MN state Medicaid agency (aka DHS) was approving autism therapy to mostly non-minority children with autism who had fee for service Medicaid. Long story short, this child’s family hired a local attorney who was also an autism mom. They sued HealthPartners and won. 

This was the gift that was going to drive my autism advocacy which we successfully advocated in both Minnesota and at the federal level to cover autism therapy for ALL Medicaid children with autism. All good, right. Not so fast. They always come up with another way to screw with our kids. In theory, health plans are supposed to follow the same rules as DHS when covering autism therapy. At least that is what I and others did back when Gov Dayton was here. We worked with state legislatures, DHS’ asst commissioner Nathan and CMS (this is a long video, I miss IACC but not the 8-hour meetings; the CMS coverage part is about 6:48 time towards the end) to ensure equity and equality. So we thought.

Now access is the law, but the rules are different similar to when black Americans were told you can vote but hold on now, you need to pass a difficult reading test. Low-income children with autism who have a health plan via Medicaid can now access the services but the rules are sooooo harder for providers. This means the provider will simply not take the MCO autistic kid which creates what? that is right more disparity, you know Minnesota’s middle name. I like to call it the land of 10,000 racial disparities.

DHS held what they are calling meet and greet events with health plans. So far two (BCBS & HealthPartners) have presented. What they said is yes we will pay for autism therapy but you will need to follow more difficult rules and processes than DHS. The provider has to get their practitioners enrolled with DHS which is good then get enrolled with the health plan which is also good. Wait for it, here comes the reading test. DHS will retro pay the services provided by the practitioners but the health plan will NOT. In other words, the agency will not be reimbursed for the therapy they have provided to the family. Now, what now? what the heck?

So this means the EIDBI agency will have to eat this cost. Tell me what agency can survive by not getting reimbursed for services they have provided? Why would any agency do this? who suffers? you guessed it – the child and the family.

I am soooooo pissed right now, I don’t even know where to start. I want to retire because I am old, tired, and have been doing this for 15 years. I do not see anyone else who wants to continue this thankless headache.

As I think through this. I really think fighting with crappy DHS or even the health plans is not the answer. We just need to write a law that says the patient has the right to opt-out of the health plan. Rep. Liebling had a bill about it this year, but Sen. Utke was against it, and it did not pass. I think we can revive this if we come at it from the patient and the provider’s perspective.

MCOs are simply not working for the member nor for the provider – period. They have unnecessary and different rules than DHS, are mostly rude, cruel even, and suck. Not a typo.

Here are my previous blogs on Medicaid paying for low-income children with autism. I mean seriously – isn’t Medicaid for the poor?

CMS approves autism coverage for the whole country!

July 8th, 2014 IACC meeting where this awesome news is announced. It is now 2022, and the fact that we are still asking for the same thing is why we have horrible and shameful racial disparities in Minnesota.

The above words do not reflect any candidate, agency, or committee.

Idil – Somali Autism Mom & Advocate

Category: Autism Policy

Comments Off on DHS Proposes changes to EIDBI – Autism Therapy

Alright – so, The Minnesota Department of Human Services (DHS) is proposing changes to amend the current early intensive developmental and behavior intervention (EIDBI). See what they are proposing and my public comments below.

Idil Abdull, Somali Autism Mom & Advocate

Submitted at 8am on June 3rd, 2022,

Comments for DHS’ proposed changes to EIDBI

Proposed changes

DHS is proposing to:

  1. Remove authorization requirements and limit on billing units for the individualized treatment plan (ITP):

This would allow providers to bill for this service as needed without authorization. Currently, the limit is 60 units to develop the ITP, with the option for providers to request an additional 30 units every six months. By removing the limit on how many units a provider can bill and the requirement to request authorization, the provider will have the flexibility to develop person-centered treatment plans and ample opportunity for progress monitoring updates. It also will ease the burden on families who transition to a new EIDBI provider agency and request an updated ITP.

My comment: First, I would like to state that I have requested the restrictions that were put on the ITP back in 2019 to be removed. DHS came back with incorrect information stating that it was CMS and not them who can do/request the changes. The idea that DHS is now asking what I have suggested years ago speaks volumes of how deaf tone the state Medicaid agency is to the needs of children with autism and their families. I want CMS to understand this and keep it in their mind. DHS does not listen to nor validate our needs, concerns, and suggestions until I usually have to complain to you at CMS. This should not be the case; the state Medicaid agency should be willing and open to suggestions from stakeholders. I respectfully ask CMS to always look at DHS’ changes to EIDBI with an extra eye and always ask them how they involved families, advocates, and providers. Do not assume what the state Medicaid agency is telling you is accurate, please verify with stakeholders.

2nd, I am confused about the wording in this change because it does not clarify what the end intent is. What I asked was to keep the 72 hours maximum we had before the 2019 code edits. Is DHS asking the same thing? Is there a limit to the initial ITP’s 60 units and 30 each six-month treatment plan?

  1. Eliminate the Technical change form, DHS-6516 (PDF):

Currently, providers submit the technical change form to DHS to request an adjustment to an existing, approved service agreement. By eliminating this step, providers would, instead, request all ITP updates or changes directly through the medical review agent.

My Comment: I did not initiate this change and I am ok with it. I support. However, please note, that DHS did not consult with families, advocates, and providers on this.

  1. To update the definition of “on-site” as it relates to high-intensity intervention (i.e., high staff ratio) services:

Currently, the QSP or Level I provider must be in the same physical location to meet the requirements of being “on-site.” DHS is proposing to update the definition of “on-site” to include that a QSP or Level I provider can be present and available via telehealth when appropriate to increase access to this essential service.

Note: A higher staff ratio is defined as two or more qualified EIDBI providers delivering the intervention to one person under the direction of an “on-site and available” qualified supervising professional (QSP) or Level I provider.

My Comment: This is fine, and I agree as it is sometimes difficult for the QSP to be present physically. Again, DHS did not consult with families, advocates, and stakeholders. They are always trying to shove down our throats their ideas without caring about how the people on the ground will be affected by their changes and rules.

The process to submit comments

Email comments to no later than 4 p.m. on Friday, June 3, 2022.

Additional input

In addition to the public comment period, DHS will consult with the EIDBI advisory group, providers, parents/guardians, and other interested parties before making these proposed changes.

Comment: I think DHS needs to do this before it suggests things. Talk with stakeholders, not at them, engage with us not dictate. Practice what you preach with action.


Idil Abdull, Somali Autism Mom and Advocate


The above words do not reflect any candidate, agency, or committee.

Idil – Autism Mom & Advocate

Category: Autism Policy