Provider Revalidation Backlog Disrupts Care for Minnesotans with Disabilities
Thousands of Minnesotans, including children receiving autism treatment and individuals needing private duty nursing, have experienced severe interruptions to essential care due to state revalidation processes and authorization backlogs.
Thousands of Minnesotans with disabilities, including children reliant on essential services, have faced profound disruptions to their care due to extensive delays in provider revalidation and subsequent treatment authorization. State processes, intended to ensure program integrity, have inadvertently created significant barriers, leaving many vulnerable individuals without access to critical support for extended periods.
After eight months of work, we now still only have two-thirds of the autism provider locations being revalidated for authorized coverage of medically necessary EIDBI treatment. But once that hard work was completed, the families and providers have now been surprised and frustrated to discover that the state's authorization contractor, Eentra, was now failing to authorize the treatment of 1,000 children, which is one-third of the entire group of children who receive TERA fee for service coverage of EIDBI in the state of Minnesota.
These pervasive delays have had severe consequences for individuals depending on consistent care. For some, the absence of authorized services has directly jeopardized their well-being, pushing them to the brink of medical crisis.
An authorization delay honestly almost cost me my life this year. I was assessed as needing and approved for private duty nursing services back in November of 2024. These services were not optional. They were determined necessary because I have significant medical needs requiring ongoing management within my home and the community. But being approved for nursing and actually receiving those nursing services have been two very different stories.
Systemic Challenges and Provider Strain
Providers across the state have also struggled significantly with the revalidation process, citing administrative burdens and communication breakdowns. Joel Bachan, CEO of Solutions, a provider operating multiple EIDBI sites in Western Minnesota, detailed the frustrations. “We have repeatedly been asked to submit the same information because data contained within the DHS system does not appear to match the information providers enter and maintain,” Bachan explained. These issues have led to severe financial strain for providers, with many experiencing lengthy payment delays for services rendered to their clients.
Other Topics from This Document
Waiver Case Management System and Reforms
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