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Frequently Asked Questions

IlliniCare Health is responsible for managing all Home and Community Based Waiver Services for the Department of Healthcare and Family Services. Waiver service providers need to bill IlliniCare Health to be paid for services rendered. Much of the current processes will stay the same. Below is a breakout of the process:

  1. Member eligibility continues to be determined by the Determination of Need (DON) tool.
  2. Based on a member's DON score, the member, along with IlliniCare Health and the member's providers, comes up with a care plan that allows the member to safely remain in their own home or in a community setting.
  3. That care plan outlines the services available and approved for the member.
  4. When a provider bills IlliniCare Health for a service, that claim will be compared to the care plan. The service provided must be included in the member’s care plan in order for providers to receive payment. We will work closely with you to educate on proper billing procedures.

For members that already have a care plan in place at the time of transition and members new to HCBS, IlliniCare Health will assist in care coordination, working closely with providers to ensure continuity of care. 

Service Package III is for individuals with developmental disabilities. If you provide waiver services to these individuals, we will contract with you at a later date.

Supportive Living Facilities will still be required to complete assessments on members prior to the member  moving into the facility. The same timelines that are required according to the state of Illinois administrative code still apply; all these assessments will continue to be completed by the SLF. IlliniCare Health will conduct our own assessments of members residing in SLFs as well.

Members are allowed 30 days for temporary absences per state fiscal year. The SLF is required to bill with a modifier during temporary absences. The modifier U1 is required. Temporary absences are defined as vacations or a hospital stay. Admission into a rehab unit or long term care facility is NOT a temporary absence, and cannot be billed with a modifier. SLFs will not be reimbursed when a member has been admitted to a LTC facility or rehab facility.

Yes. For any provider that comes to the SLF, they must be contracted with IlliniCare Health, and follow any prior authorization requirements. If they are not contracted with IlliniCare Health, prior authorization is needed for all services.