Minnesota’s Autism-Authorization Bottleneck Leaves ABA Families Waiting and Providers Without Cash to Operate

A Thousand Plans in the Queue

ST. PAUL, MINNESOTA – About 1,000 Minnesota children and their families are waiting on autism treatment plan approvals, according to Eric Larsson, executive director of clinical services at the Lovaas Institute Midwest, who told CBS News Minnesota that state officials gave providers the figure in mid-August. The Minnesota Department of Human Services (DHS) did not address the number in the statement CBS published. Until a plan is approved, the provider cannot bill Medicaid for the child’s therapy.

Minnesota Behavioral Specialists, an ABA provider with a center in Bloomington, has 11 children whose plans are unapproved; some were submitted in June, co-owners Paige Berland and Camille Heyman told the station. Berland said the owners were “taking out personal loans, cashing out 401ks at a personal level,” and that the company could last roughly three more months if nothing changes.

Loni Yego, whose 3-year-old son’s plan is pending, told CBS: “I don’t even know where to go because there’s no communication right now.”

EIDBI (Early Intensive Developmental and Behavioral Intervention) is Minnesota’s Medicaid autism benefit. Under it, direct intervention, observation and direction (CPT 97155), caregiver training and travel time all require authorization before delivery, and the Individual Treatment Plan (ITP) is the document that carries those requests. No single authorization can cover more than 180 days, so every child’s plan comes back through the queue at least twice a year.

The Five-Day Standard in Acentra’s Contract

The contractor is Acentra Health, the McLean, Virginia, company formed from the 2022 merger of Kepro and CNSI and owned by the private equity firm Carlyle. It is the medical review agent for Minnesota Health Care Programs and, for children in fee-for-service Medicaid, reviews every Comprehensive Multi-Disciplinary Evaluation (CMDE) and treatment plan that providers submit through its Atrezzo portal.

The department’s own provider manual sets the clock. Acentra is to take initial action, meaning approve, deny or pending for more information, within five business days of receiving a request; a pending case gives the provider 10 calendar days to respond, and Acentra then has three business days from receiving the information to decide. A separate notice in December 2025 told providers that, effective January 1, 2026, Acentra would review CMDEs and treatment plans within seven calendar days. The five-business-day clock is the contract standard DHS cited to CBS; the seven-calendar-day timeline covers the plan review steps in the EIDBI manual.

In its statement to CBS, DHS said: “Acentra’s contract includes strict performance requirements and financial penalties. Acentra must act on 98% of authorization requests within five business days, and failure to meet that standard results in forfeiture of a portion of their payment.” DHS is overseeing a corrective action plan that includes training new staff and streamlining the process, CBS reported.

“If Acentra cannot resolve the backlog within the required timeline, DHS will evaluate next steps, which may include continued remediation, removing noncompliant services from the contract, or terminating the contract for breach.” – Minnesota Department of Human Services, statement to CBS News Minnesota (2026)

Acentra attributed the pileup to volume. EIDBI referrals have risen 144% since 2022, the company told CBS, adding: “We have hired highly skilled staff to process cases, and we are rapidly aligning internal resources to meet this exponential demand to reduce the backlog.” Neither party put a date on clearing the queue in the CBS report.

One provision in the manual softens the financial blow, at least on paper: Acentra “may retroactively approve up to 180 days for services that require authorization.” A clinic that keeps treating a child during the wait may be paid for that care later if Acentra approves the plan and applies the retroactive provision; until then, it cannot bill.

The Overhaul DHS Links to the Backlog

A DHS spokesperson told CBS that part of the backlog stems from the agency’s overhaul of the Medicaid system after the fraud crisis in programs deemed high risk, EIDBI among them. The department says it has completed 444 on-site EIDBI visits, opened 73 investigations and made 25 law enforcement referrals since October 2024.

The overhaul has several parts. DHS designated EIDBI high-risk in spring 2025, issued an EIDBI enrollment moratorium in November 2025, and put the program’s claims under Optum’s pre-payment review in December 2025, according to the department’s April 7 presentation to the House Fraud Prevention and State Agency Oversight Policy Committee. On January 27, 2026, in coordination with CMS, the state froze new provider enrollments across 13 high-risk service categories.

The authorization rules themselves changed on January 1, 2026. Requests for observation and direction now need individual clinical justification, and DHS pointed providers to national guidance recommending observation and direction at 20% of direct treatment hours; exceptions above that level require a person-specific justification that the medical review agent or managed care plan must approve.

In February DHS revised two sections of the treatment plan form, DHS-7109, and told providers to use the new version for initial plans starting March 1 “to avoid rejections or delayed authorizations”; as of September 1, the old form is no longer accepted for any plan.

Volume has grown as well. Nearly 1,400 children under 21 received EIDBI services in 2020; more than 5,600 did in 2024, while annual program cost rose from $38 million to $325 million, the Office of the Legislative Auditor reported in March. The Minnesota Reformer put 2025 spending at $443 million.

Providers Already Absorbed Two Payment Shocks

The authorization stall is landing on agencies that have taken two payment hits in the past nine months. When the pre-payment review took hold at the end of December, Holland Autism Centers founder Jennifer Larson told KSTP the state “held 100% of the claims,” and that she borrowed $200,000 to cover a single payroll at a company where Medicaid is about 80% of revenue. DHS said at the time it had no way to expedite payments for individual providers.

Then came revalidation. Under pressure from CMS, which threatened to withhold $2 billion in federal Medicaid funding, DHS re-screened almost 5,600 high-risk providers in five months and disenrolled 3,411 of them as of May 31, a process the department says “was not a fraud determination.” “This was not the plan,” Deputy Commissioner John Connolly told CBS in July, saying the department had hoped most providers would be revalidated within the timeline. By the time of that July 1 report, 2,472 disenrolled providers had appealed, and about 321 appeals had been decided as of June 29.

What providers do not have is a date. The plans Minnesota Behavioral Specialists filed in June have now waited more than two months; the manual gives Acentra five business days to take initial action on a request. DHS has said it will evaluate “next steps” if Acentra cannot resolve the backlog within the required timeline, but the statement, as CBS published it, did not specify that timeline, and neither DHS nor Acentra had publicly announced a date for clearing the queue as of this writing. By December 31, 2026, DHS must also decide the 433 provisional license applications it received from EIDBI sites, a second queue running alongside the first.

AT A GLANCE

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