by IABA Team | Mar 8, 2022
The PUNS list (Prioritization of Urgency of Need for Services) is a database in Illinois that tracks the current services and future needs of persons with developmental disabilities. The list was a way of prioritizing the needs of children in Illinois. The PUNS list will not be used for children in need by 2023, as other Medicaid services become available to help with autism services.
While the PUNS list was an important resource in the past, families will also need to be aware of new EPSDT (Medicaid) benefits and how to navigate through them. Families who are familiar with the PUNS list & services offered should look at those services and be aware of what is being continued & discontinued through EPSDT versus continued Waiver Funding.
What does the PUNS List Look At?
The PUNS list primarily focuses on three aspects of coverage:
- Community Integrated Living Arrangements
- Home Based Supports
- Child Group Homes
These are the primary focus due to the magnitude of the developmental disabilities of qualifying individuals. Needing help with specialized living arrangements takes top priority on the PUNS list.
Other needs the PUNS list looks at include:
- In-Home Supports
- Job Coaches
- Community Day Services
- Residential Services
- Therapy Services
These are secondary focuses of the PUNS list, based on priority of needs. Individuals still able to live comfortably at home but still needing healthcare services are the secondary focus of the PUNS list.
The other major factor for priority on the PUNS list is time. Many people in need are on the PUNS list for years before their case is finally accepted by the state.
Waiting for the PUNS list
The PUNS list has 2 categories for individuals seeking help:
- Seeking Services (category for people who currently need or desire supports)
- Planning for Services (category for people who do not currently want or need supports but may in the future).
The seeking services category is the primary focus for priority on the PUNS list, as the individuals in this category actively need help. PUNS selections are based on a person’s cumulative length of time in the Seeking Services Category. As funding is available, individuals are selected from PUNS and invited to apply for DD Waiver services.
The wait for priority on the PUNS list could take years of waiting for families in need of immediate assistance. As more social service programs from Medicaid have become available, the PUNS list has slowly started to fade away.
The PUNS list is basically a waiting list with special criteria. Appealing the speed at which applicants receive help is nearly impossible, as the list is handled internally by the state. The PUNS list started with children in need of medical services as a large portion of the list but has slowly morphed into a priority list for adults who have alternative housing needs.
IABA Consultants & PUNS
To date, as of March 2022, IABA consultants is still the only ABA provider offering services to individuals on the PUNS list. PUNS has primarily morphed into a service used for adults and will actually stop funding children in 2023.
IABA Consultants will stop accepting waivers from the PUNS list in 2023, as children will no longer be covered. However, starting in July 2022 IABA will be supporting our current PUNS clients to help with access to ABA benefits available through EPSDT. IABA will continue to provide behavioral therapy to adults with developmental disabilities through the PUNS waiver.
As of March 2022, IABA Consultants has started accepting Illinois Medicaid as a billing provider. More children are being accepted into the Illinois Medicaid All Kids program, allowing proper funding to be allocated to those in need.
If you have a child who has been waiting on the PUNS list and want to learn more about the Illinois Medicaid All Kids program, click here.
ABA Therapy from IABA Consultants
IABA consultants is now accepting All Kids Medicaid!
Medicaid Clinic Timeline:
- Oak Lawn: Current
- Naperville: May 2022
- Glenview: Summer 2022
- Managed Care Plans: Summer 2022
Dates are tentative and may be subject to change.
For details and coverage information, find the location closest to you and give us a call or send us an email.
If you have questions regarding autism treatment, education, or plans to use ABA therapy, we are here for you! Our goal is to make sure no family is turned away due to financial constraints. Our therapy team would love to talk to you. Find the location closest to you and give us a call. We’re here for you.
by IABA Team | Mar 1, 2022
As of March 2022, IABA Consultants is accepting Illinois Medicaid All Kids members! We have been working hard over the past year to make sure everything is in place for proper billing and services. Let’s go over what we’ve done and what to expect with Medicaid and ABA therapy services here at IABA Consultants.
Getting Approved for Medicaid & ABA Services
The process for us to accept Medicaid as an insurance provider took a long time mainly because ABA therapy & services have only very recently been accepted for coverage by Medicaid. October 2021 was the first time the state of IL listed ABA therapy services as billable by Medicaid for children with autism.
When a new area of coverage makes its way into Medicaid coverage, there was a lot of red tape to get through. ABA services were no different. We have finished the state auditing process to become a Behavioral Health Clinics and hired licensed clinical social workers (LCSW) to get on the same page for helping families with Medicaid. ABA therapy Medicaid coverage is a totally new field, so everyone on our team needed to learn.
Medicaid ABA Services at IABA Consultants
The programs we create for individuals with Medicaid will be nearly identical to those of individuals with private insurance. Each person is different, so care plans and services need to be carefully constructed.
While the general ABA services are currently the only therapy we offer (as of March 2022), we have plans for more in the future. Our LCSWs have started working on the following supplemental care services:
- Social skills groups (tentatively scheduled for summer 2022)
- LCSW-led groups
- Resource library for families & clients
Other possibilities we want to look at down the road include:
- Crisis teams for extreme behaviors
- On-staff psychologists
- Parental care programs for at-risk families
- Counseling (both individual and family)
- Medication monitoring & management
We are also working on getting in-home ABA therapy added to our Medicaid programs. Given the demand for in-home services, we are currently adding and training staff. There are also certain aspects of in-home therapy that make RBT requirements more specific for Medicaid children. We will update Medicaid & in-home services as soon as we have staff available.
Having social workers on staff has led us to some interesting ideas that will benefit all of our clients regardless of funding.
ABA Therapy from IABA Consultants
IABA consultants is now accepting All Kids Medicaid!
Medicaid Clinic Timeline:
- Oak Lawn: Current
- Naperville: May 2022
- Glenview: Summer 2022
- Managed Care Plans: Summer 2022
Dates are tentative and may be subject to change.
For details and coverage information, find the location closest to you and give us a call or send us an email.
If you have questions regarding autism treatment, education, or plans to use ABA therapy, we are here for you! Our goal is to make sure no family is turned away due to financial constraints. Our therapy team would love to talk to you. Find the location closest to you and give us a call. We’re here for you.
by IABA Team | Feb 26, 2022
A Licensed Practitioner of the Healing Arts (LPHA) in Illinois can be legally defined in several ways. The important definitions for the sake of this blog will be listed, as some definitions are not applicable to autism or ABA therapy services.
- A clinical psychologist who holds a valid license in the state of practice and is legally authorized under state law or rule to practice as a clinical psychologist, so long as that practice is not in conflict with the Clinical Psychologist Licensing Act
- A licensed clinical professional counselor possessing a master’s degree who holds a valid license in the state of practice and is legally authorized under state law or rule to practice as a licensed clinical professional counselor, so long as that practice is not in conflict with the Professional Counselor and Clinical Professional Counselor Licensing Act [225 ILCS 107]
- A clinical social worker possessing a master’s or doctoral degree who holds a valid license in the state of practice and is legally authorized under state law or rule to practice as a social worker, so long as that practice is not in conflict with the Clinical Social Work and Social Work Practice Act.
LPHAs & ABA Therapy
LPHAs are important when it comes to ABA therapy service providers and Medicaid. Many service providers are nationally licensed for Medicaid, with state licensure being an afterthought. If a provider is nationally certified by Medicaid but not certified at the state level, they need to be supervised by an LPHA.
Medicaid treatment plans using ABA therapy and services must be supervised by an LPHA for billing. An LPHA will supervise programs, time, & service professionals and how Medicaid should be billed.
LPHAs are not required to have contact with clients–they simply manage billing and other backend processes. If a billing conflict arises, LPHAs will contact service providers in order to figure out what is going on with a certain expense.
ABA Therapy from IABA Consultants
IABA consultants is now accepting All Kids Medicaid!
Medicaid Clinic Timeline:
- Oak Lawn: Current
- Naperville: May 2022
- Glenview: Summer 2022
- Managed Care Plans: Summer 2022
Dates are tentative and may be subject to change.
For details and coverage information, find the location closest to you and give us a call or send us an email.
If you have questions regarding autism treatment, education, or plans to use ABA therapy, we are here for you! Our goal is to make sure no family is turned away due to financial constraints. Our therapy team would love to talk to you. Find the location closest to you and give us a call. We’re here for you.
by IABA Team | Feb 19, 2022
Medicaid in Illinois has 2 types of plans that are commonly given to children–All Kids and Managed Care plans. The short version of what these 2 packages are can be summed up by saying All Kids is a complete health insurance plan while Managed Care is a recommended care plan where some things may not be covered.
Both of these plans have specific uses for those in need of healthcare. Applications need to be submitted and approved before any coverage is granted.
So, what are the differences between All Kids and Managed Care when it comes to benefits and uses? Let’s take a look.
Illinois Medicaid All Kids
All Kids is, quite simply, a complete health insurance package for a child in need.
Illinois’ All Kids program is for children who need comprehensive, affordable, health insurance, regardless of immigration status or health condition. All Kids covers:
- Doctor visits
- Hospital stays
- Prescription drugs
- Vision care & glasses
- Dental care
- Regular check-ups
- Immunization shots
- Medical therapy
- Speech therapy
- Physical therapy
- ABA services (As of October 2020)
To receive All Kids benefits, a family & child must meet several criteria. Check out the Illinois All Kids webpage for more information.
Click here to visit the State of Illinois application page.
Illinois Medicaid Managed Care
Managed care is a kind of health insurance program. When you enroll in managed care, you become a member of a Health Plan. You will have at least 5 Health Plans to choose from depending on where you live. The Health Plan you choose will offer you a full range of services while helping you coordinate your health care.
- Your health care needs
- Help manage your health care conditions
- Give you information you need to stay healthy
- Help you identify your health goals and create a care plan to achieve those goals
- Answer questions about your care
- Find a doctor or specialist
- Transition out of a hospital or facility
- Provide community resources
Unlike All Kids, managed care is not a comprehensive health plan. Managed care plans can help you find the care you need, but may not cover all the costs. Be sure to talk to a Medicaid representative if you have questions.
ABA Therapy from IABA Consultants
IABA consultants is now accepting All Kids Medicaid!
Medicaid Clinic Timeline:
- Oak Lawn: Current
- Naperville: May 2022
- Glenview: Summer 2022
- Managed Care Plans: Summer 2022
Dates are tentative and may be subject to change.
For details and coverage information, find the location closest to you and give us a call or send us an email.
If you have questions regarding autism treatment, education, or plans to use ABA therapy, we are here for you! Our goal is to make sure no family is turned away due to financial constraints. Our therapy team would love to talk to you. Find the location closest to you and give us a call. We’re here for you.
by IABA Team | Feb 12, 2022
ABA therapy only recently became available as a Medicaid-covered health option in October of 2021. ABA therapy and related services are needed more every year, but can be too expensive for many families. Medicaid coverage can alleviate the financial burden and allow families to get the care they need.
What ABA Services & Programs are Covered by Illinois Medicaid?
The state of Illinois only recently (2021 federal EPSDT mandate) recognized ABA therapy as a valid medical service for ASD and other behavioral issues. Illinois Medicaid can cover the following services:
- Behavioral health services
- Licensed clinical psychologists
- Licensed clinical social workers (LCSW)
- Board-certified behavioral analysts
- Registered behavior technicians
- Specialists in any of the above categories
Clinical psychologists and LCSWs can oversee and evaluate behavioral programs conducted by BCBAs or RBTs. Medicaid funding is required that a state-licensed Licensed Professional of the Healing Arts (like a clinical psychologist and LCSW) supervise BCBA treatment plans for individual plans to cover ABA services. The behavioral programs are created based on individual needs and get input from clients, families, and healthcare professionals. All behavior programs must be formally created using behavioral analyst assessments (like the ABLLS/VB-MAPP) and have measurable goals on their behavioral treatment plan as required by Medicaid.
Finding a Provider for Medicaid ABA Therapy
The biggest hurdle for anyone looking to secure Medicaid-covered ABA services is the lack of providers. ABA therapy is allowed to be covered through Medicaid, but ABA services providers don’t have to accept Medicaid.
The best way to find an ABA service provider that accepts Medicaid is to talk to your child’s doctor or psychologist and ask about clinics or services that accept Medicaid. LCSWs are also a great way to find a provider that accepts Medicaid (LCSW services may be covered under your Medicaid plan).
Medicaid Managed Care for ABA Therapy
Be sure to get information about both the Medicaid All Kids and Managed Care before applying. Managed Care programs are not actually handled by Medicaid–they are handled by contracted insurance providers (In Illinois the providers are Blue Cross Blue Shield IL and Meridian).
While All Kids is directly handled by Illinois Medicaid, Managed Care is handled by contracted outside insurance providers who report to the state. Managed Care programs may make different recommendations based on the insurance provider who manages a given plan. This may happen by recommending children to a specific in-network provider for a given service (in-network for BCBS Community or Meridian).
The coverage varies greatly from All Kids to Managed Care programs, so make sure the services your child needs are covered by any Managed Care program you are considering.
ABA Therapy from IABA Consultants
IABA consultants is now accepting All Kids Medicaid! For details and coverage information, find the location closest to you and give us a call or send us an email.
If you have questions regarding autism treatment, education, or plans to use ABA therapy, we are here for you! Our goal is to make sure no family is turned away due to financial constraints. Our therapy team would love to talk to you. Find the location closest to you and give us a call. We’re here for you.
