Early Intensive Behavioral Intervention (EIBI)

Massachusetts Commercial products, Tufts Health Direct, Tufts Health Together

October 01, 2021  
Effective for dates of service on or after October 1, 2021, Tufts Health Plan now covers EIBI for

Massachusetts Commercial products, Tufts Health Direct and Tufts Health Together – MassHealth MCO Plan and Accountable Care Partnership Plans (ACPPs) for members under three years of age and who meet the medical necessity criteria. Note: EIBI will not require prior authorization or notification.

EIBI is a service that works in conjunction with early intervention programs to address the needs of the family related to enhancing the child’s development and is provided by a Specialty Service Provider (SSP) that is certified by the Massachusetts DPH to work with infants and toddlers with low incidence conditions and their families. EIBI is designed to offer intensive intervention to children with a diagnosis of Autism Spectrum Disorder as defined in the Diagnostic and Statistical Manual (DSM-V). Note: The diagnosis must be obtained from a physician or licensed psychologist.

For more information, refer to the Outpatient Behavioral Health and Substance Use Disorder Payment Policy for Massachusetts Commercial products, the Outpatient Behavioral Health (Mental Health & Substance Use Disorder) Payment Policy for Tufts Health Public Plans products and the Medically Necessity Guidelines for Early Intensive Behavioral Intervention (EIBI).