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Waiver services

Aetna Better Health® of Illinois manages all home- and community-based services (HCBS) waivers for members who qualify. Services provided under the waiver program allow members to live independently in their homes. There are a variety of different services that are included in each waiver. And these services are all aimed at helping the member live independently. Services include: 

Determination of Need (DON) assessment

Members work with a state agency to complete the assessment to qualify for waiver services. It includes a series of questions to assess if the member can perform daily living activities and to assess the member’s mental acuity and their levels of impairment and need. 

 

The DON is conducted by the Illinois Department on Aging or the Illinois Department of Human Services’ Division of Rehabilitation Services. We may have an Aetna Better Health of Illinois care coordinator present during a member’s DON assessment. 

 

Once the DON is complete and if the member qualifies, Aetna Better Health of Illinois creates a care plan. It includes services that allow the member to remain safely in their home or community. 

Prior authorization

Prior authorization is needed for HCBS waivers. Aetna Better Health of Illinois has 90 days of continuity of care in place. This means that we won’t change any care plans for Aetna Better Health of Illinois members during the 90-day transition period. Our HCBS program specialists and HCBS utilization management staff will enter prior authorizations into the system for each member who is currently receiving waiver services, according to their current care plan. 

 

Providers don’t need to contact us to submit a prior authorization form. It will be handled by the HCBS program specialist as they are coordinating services for the member.  

 

For additional details, please visit our prior authorization page.