Aetna Better Health® of Illinois handles managing all Home and Community Based Waiver Services (HCBS) waivers for the Department of Healthcare and Family Services. Waiver service providers need to bill us to receive payment for services given. Much of the current processes will stay the same. Below is a breakout of the process:
Member eligibility continues to be determined by the Determination of Need (DON) tool.
Based on a member's DON score, the member, along with Aetna Better Health of Illinois and the member's providers, create a care plan that allows the member to safely remain in their own home or community setting.
That care plan outlines the services available and approved for the member.
When you bill us for a service, that claim will be compared to the care plan/authorization. The service supplied must be authorized and included in the member’s care plan for you to receive payment. We’ll help you with proper billing procedures.
We’ll work with you closely to ensure continuity of care for members who already have a care plan in place at the time of transition and for members new to HCBS.
Members are allowed 30 days for temporary absences per state fiscal year. The SLP must bill with the modifier U1 during temporary absences. Temporary absences are defined as vacations or hospital stays. Admission into a rehab unit or LTC facility isn’t a temporary absence and can’t be billed with a modifier. SLPs won’t be reimbursed when a member has been admitted to an LTC facility or rehab facility.
Yes, you must be contracted with Aetna Better Health of Illinois and follow any prior authorization requirements. If you aren’t contracted with us, prior authorization is needed for all services.
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