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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:
The Elderly waiver is for people 60 years or older who live in the community.
Services include:
Adult day care
Transportation to adult day care
Homemaker
Personal emergency response system
Automated medication dispenser
The Persons with Disabilities waiver is for people ages 19 to 59 who have a physical disability.
Services include:
Adult day care
Transportation to adult day care
Environmental accessibility adaptations at home
Home health aide
Intermittent nursing
Skilled nursing with RNs or LPNs
Occupational therapy
Physical therapy
Speech therapy
Homemaker
Home-delivered meals
Personal assistant
Personal emergency response system
Respite
Specialized medical equipment and supplies
The Persons with HIV or AIDS waiver is for people who have been diagnosed with HIV or AIDS.
Services include:
Adult day care
Transportation to adult day care
Environmental accessibility adaptations at home
Home health aide
Intermittent nursing
Skilled nursing with RNs or LPNs
Occupational therapy
Physical therapy
Speech therapy
Homemaker
Home-delivered meals
Personal assistant
Personal emergency response system
Respite
Specialized medical equipment and supplies
The Persons with Brain Injury waiver is for people with an injury to the brain.
Services include:
Adult day care
Transportation to adult day care
Environmental accessibility adaptations at home
Supported employment
Home health aide
Intermittent nursing
Skilled nursing with RNs or LPNs
Occupational therapy
Physical therapy
Speech therapy
Prevocational services
Day habilitation
Homemaker
Home-delivered meals
Personal assistant
Personal emergency response system
Respite
Specialized medical equipment and supplies
Behavioral services with practitioners who have an MA or a PhD
The Supportive Living Program waiver services include:
- Intermittent nursing
Meals and snacks
Medication oversight
Personal care
Social and recreational programming
Health promotion and exercise programming
24-hour response and security staff
Emergency call system
Laundry
Housekeeping
Maintenance
Well-being check
Ancillary services
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 care coordinators 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 care coordinator as they are coordinating services for the member.
For additional details, please visit our prior authorization page.