CountyCare ABA coverage: the intake guide.

CountyCare is the HealthChoice Illinois plan run by Cook County Health and serves Cook County only. It covers ABA under HFS’s ABS benefit. In 2026 it removed prior authorization from the two assessment codes but kept it on treatment, which makes it the most conservative of the Illinois plans on the treatment side.

Authorization: assessments free, treatment authorized

CountyCare’s February 2026 notice: “Effective January 1st, 2026, there are no prior authorization requirements for ABA/ABS Behavior Identification Assessment and Supporting Assessments. Providers are directed to submit claims for these services rendered.” It lists 97151 and 97152, and adds: “additional services for ABA/ABS treatment and support will require prior authorization for outpatient behavioral health services,” with the code-level rules in the Authorization Look-Up Tool. The provider manual (January 2025) lists ABA among behavioral health services that require PA, takes PA requests by phone (312-864-8200 or 855-444-1661), portal or behavioral health fax 800-498-8217, and “renders decisions on routine prior authorization requests within four (4) calendar days following receipt of the request” and urgent requests within 48 hours.^{[13][14][2][3][15][16][17][18]}

Illinois Public Act 104-0028 (HB 3019) changed behavioral health utilization management from January 1, 2026, and each HealthChoice Illinois plan has read it differently for ABA. Molina says ABA “services are no longer eligible for prior authorization and require concurrent review only” (no authorization for the initial assessment or the first 48 units of therapy a calendar year). Aetna Better Health approves 97151/97152 without medical-necessity review if notified within one business day, then runs concurrent review. Blue Cross Community Health Plans and YouthCare ask for notification within 24 hours of starting ABA services or the initial assessment. Meridian requires notice within 24 hours of 97151/97152 from May 1, 2026 and keeps prior authorization on treatment. CountyCare removed PA from 97151/97152 only. The Act itself added subsection (w) to 215 ILCS 5/370c: from January 1, 2026 “No policy shall require prior authorization for outpatient or partial hospitalization services for treatment of mental, emotional, or nervous disorders or conditions,” such coverage “may be subject to concurrent and retrospective review,” and “A Medicaid managed care organization may set a deadline of 24 hours after the initiation of treatment” for notification (one more business day if it cannot accept the notice). It also lets HFS “adopt rules to implement the applicable provisions” for managed care organizations “and the medical assistance fee-for-service program” (new 305 ILCS 5/5-5.28). The statute does not name ABA, which is why the plans differ; this guide reports each plan’s own written rule.^{[13][14][2][3][15][16][17][18]}

Claims, disputes and continuity of care

Clean claims are due “within one hundred eighty (180) calendar days from the date of service”; 90 percent of clean claims are processed within 30 days and 99 percent within 90 days. Provider disputes are due within 60 calendar days of the Explanation of Payment. Electronic claims use payer ID 06541. For members joining CountyCare mid-treatment, behavioral health outpatient services including ABA get continuity of care when the member was treated in the previous 90 days for an existing condition; “Members have ninety (90) days to transition to an in-network provider.” CountyCare, “like all Medicaid programs and plans, is always the payer of last resort.” Illinois law sets the payment clock for every HealthChoice Illinois plan: under 305 ILCS 5/5-30.1(g), “The MCO shall pay a claim within 30 days of receiving a claim that contains all the essential information needed to adjudicate the claim,” must notify the billing party within 30 days when it cannot adjudicate a claim, and owes a late-payment penalty at least equal to the Insurance Code’s timely-payment interest, calculated and paid within 30 days after the claim is paid, without the provider having to ask for it. No plan document we read publishes a weekly submission cutoff or check-run day; ask the plan’s provider services for its payment cycle.^[3][1]

Intake gates

The questions that decide whether a family can start with CountyCare Health Plan (Cook County), and what they have to bring. Each maps onto something intake should ask on the first call.

Delivery & billing rules

Coverage decides whether CountyCare Health Plan (Cook County) pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

Common questions

Carelu collects all of this automatically.

Every ID, document, and detail this payer requires — gathered conversationally the moment a family reaches out, with insurance verified before your team touches the file.