Acentra’s Minnesota Contract at Risk as Autism Approvals Stall. Providers and Families Face Uncertainty

What DHS Has Confirmed

ST. PAUL, MINNESOTA – The Minnesota Department of Human Services (DHS) acknowledged delays in autism service authorizations on Aug. 25, saying its medical review agent, Acentra Health, was taking longer than required because of increased review volume. The notice gave no backlog count. In a Sept. 4 CBS News Minnesota report, Lovaas Institute executive director Eric Larsson said state officials had told providers in mid-August that 1,000 children and their families were waiting for treatment plan approvals.

Early Intensive Developmental and Behavioral Intervention (EIDBI) is Minnesota’s benefit for eligible people under 21 with autism or related conditions. Acentra reviews requests for fee-for-service Medicaid members; managed care plans handle authorizations for their own members. Fee-for-service accounted for about one-quarter of EIDBI’s $324.9 million cost in 2024, according to the Office of the Legislative Auditor.

DHS said Acentra would prioritize initial evaluations and treatment plans, as well as plans approaching the end of a service agreement or an authorization gap. The notice also identified avoidable delays from incorrect routing, incomplete submissions, and duplicate requests. Requests for managed care members must go to their health plan, not Acentra. Separately, a DHS spokesperson told CBS that changes tied to the state’s Medicaid overhaul contributed to the backlog.

Neither the Aug. 25 notice nor DHS’s statement to CBS gave a date for clearing the backlog. DHS described a contract standard requiring Acentra to act on 98% of requests within five business days or forfeit part of its payment.

What the 180-Day Limit Does and Does Not Explain

The Aug. 25 notice reiterates that Acentra may approve authorizations retroactively for up to 180 days and will deny requested service dates beyond that window. The EIDBI provider manual states the same limit. It also imposes a separate restriction: a single authorization may cover no more than 180 days of services. Neither provision explains which date anchors the lookback for a request delayed in review.

“Acentra Health cannot retroactively approve authorizations beyond 180 days and will deny the requested dates of service beyond that time.” – Minnesota Department of Human Services, Aug. 25, 2026 provider notice

The manual requires authorization before providers deliver direct intervention, observation and direction, caregiver training, or travel time. It also requires a signed comprehensive multidisciplinary evaluation and individual treatment plan before services begin. A clinic that provides care while a request is pending risks nonpayment: retroactive authorization has conditions, and even an approved service agreement does not guarantee payment.

Acentra’s September 2024 checklist refers to requests backdated by up to six months, but it does not establish whether DHS counts from submission, a later resubmission, or the decision date. A May 2025 Acentra notice warned that an inadequate response to a request for corrections could lead to rejection and require a new case. It did not explain how that would affect the retroactive window. The current EIDBI manual gives providers 10 calendar days to respond when Acentra requests more information.

DHS advises filing at least 30 days before services begin, checking requests in Acentra’s Atrezzo portal, and avoiding nonurgent status inquiries so reviewers can complete requests.

Three Options DHS Has Named

DHS told CBS that if Acentra cannot resolve the backlog “within the required timeline,” its next steps “may include continued remediation, removing noncompliant services from the contract, or terminating the contract for breach.” The reported statement did not specify a deadline.

Corrective action is already underway. DHS is overseeing a plan that includes training new staff, CBS reported. Acentra attributed the pressure to a 144% increase in EIDBI referrals since 2022 and said it had hired staff to process cases. DHS said the contract requires Acentra to forfeit part of its payment if it misses the 98% standard. Neither the Aug. 25 notice nor the statement reported by CBS disclosed the contract’s value or confirmed that DHS had withheld payment.

Removing noncompliant services would narrow the work covered by the contract, but those statements do not identify a replacement arrangement.

The consequences of termination would depend on Acentra’s executed agreement. Minnesota’s standard professional and technical services contract allows cancellation with or without cause on 30 days’ written notice, but that sample does not establish the terms governing this contract. The reviewed statements also do not explain who would handle pending cases after a change. Colorado’s experience offers a caution about transitions: the state acknowledged missed turnaround standards when Kepro, Acentra’s predecessor, began reviewing requests in 2021.

Acentra’s work extends well beyond Minnesota. The McLean, Virginia, company said on Aug. 13, 2026, that it served 22 state utilization management clients and had secured a five-year extension in Colorado. Acentra adopted its current name in 2023 after combining CNSI and Kepro.

Federal Deadlines and New Review Rules

Since Jan. 1, 2026, federal rules have required Medicaid fee-for-service programs to decide standard prior authorization requests as quickly as the patient’s condition requires and within seven calendar days. States may extend that period by up to 14 days if the patient or provider requests an extension, or the state needs more information. Expedited decisions are due within 72 hours, subject to shorter state deadlines. DHS’s December 2025 notice likewise set a seven-calendar-day review period for EIDBI evaluations and treatment plans. A five-business-day standard for initial action is a different measure: the state’s general manual allows that action to be an approval, denial, or request for more information.

Federal public reporting began in 2026. By March 31 each year, states must post the previous year’s prior authorization metrics, excluding drugs. The required measures include approval and denial rates and average and median decision times for standard and expedited requests.

Minnesota also changed EIDBI documentation requirements on Sept. 1, 2026. Providers must support service intensity with assessed needs and objective clinical evidence, document coordination with schools and case managers, and periodically demonstrate continued need. DHS stopped accepting the old individual treatment plan form that day. Further changes are scheduled: the 2026 Legislature adopted EIDBI billing limits that apply July 1, 2027, or upon federal approval, whichever is later. The law requires the commissioner to grant exceptions when services beyond those limits are medically necessary.

The 2026 federal metrics are due March 31, 2027. They will provide statewide measures across services, but the rule does not require a separate EIDBI backlog report. Those figures alone will not show how many autism treatment plans remain pending, how old those requests are, or whether families avoided gaps in care. A dated recovery plan and EIDBI-specific queue data would give providers and families a clearer account of whether the delays are ending.

AT A GLANCE

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