---
title: "CountyCare ABA coverage: the intake guide."
url: "https://carelu.com/payers/countycare-illinois"
markdown_url: "https://carelu.com/payers/countycare-illinois.md"
state: IL (Illinois)
payer: CountyCare Health Plan (Cook County)
kind: Medicaid managed care plan (MCO)
parent_program: Illinois Medicaid (HealthChoice Illinois)
description: "How CountyCare Health Plan, Cook County’s HealthChoice Illinois plan, covers ABA: no PA on assessments since 2026, PA on treatment, decision and claims deadlines, continuity of care, and what intake should collect."
last_reviewed: October 2026
---

# CountyCare ABA coverage: the intake guide.

_Payer Guide · CountyCare · Illinois · Last updated October 2026 · 12 primary sources_

> Cook County Health’s HealthChoice plan: no PA for 97151/97152 from 1/1/2026; ABA treatment still needs PA (4-day routine decisions).

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.

This plan administers the **Illinois Medicaid (HealthChoice Illinois)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [Illinois Medicaid (HFS) guide](https://carelu.com/payers/illinois-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: No. “Effective January 1st, 2026, there are no prior authorization requirements for ABA/ABS Behavior Identification Assessment and Supporting Assessments” (97151, 97152) [2]
- **Prior auth for treatment**: Yes. “Additional services for ABA/ABS treatment and support will require prior authorization for outpatient behavioral health services”; the manual’s PA table lists “IOP, PHP, ABA: Required” [2][3]
- **Autism diagnosis required?**: Yes. CountyCare publishes no ABA criteria of its own in the documents read, so HFS’s rule applies: ASD documented by a Comprehensive Diagnostic Evaluation (physician or clinical psychologist; ADOS, GARS, ADI or CARS) [3][4]

## At a glance

- **Covers ABA?:** Yes, under HFS’s ABS benefit (ages 0–20, ASD); Cook County residents only
- **Assessment:** No PA for 97151/97152 from 1/1/2026
- **Treatment:** Prior authorization required (check the Authorization Look-Up Tool)
- **Decision clock:** Routine PA 4 calendar days; urgent 48 hours
- **Timely filing:** 180 calendar days from date of service; payer ID 06541
- **Continuity:** Members treated in the past 90 days get 90 days to move to an in-network ABA provider

## 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.

- **Age limit**: Under 21: HFS covers ABS for children 0 through 20; CountyCare publishes no different limit. [19][3]
- **Diagnosis recency**: CountyCare publishes nothing of its own. HFS: a CDE more than 24 months old needs current functional-impairment documentation. [3][4]
- **Who may diagnose**: CountyCare publishes nothing of its own. HFS: physician or clinical psychologist. [3][4]
- **Diagnostic tools required**: CountyCare publishes nothing of its own. HFS: ADOS, GARS, ADI or CARS. [3][4]
- **Referral required?**: CountyCare publishes nothing of its own. HFS requires a physician order and referral, valid one year. [3][4]
- **Telehealth**: CountyCare’s manual describes telehealth only generally and points to the IAMHP billing guide; it has no ABA rule, so HFS’s applies. HFS’s ABS fee schedule (updated 05/14/2026) marks four codes for remote delivery: 97151 (assessment), 97155 (protocol modification), 97156 (family guidance) and 97157 (multiple-family group). The footnote reads: “Only use the GT or 93 modifier when providing allowable service remotely as a distant site telehealth service along with Place of Service (POS) 02 or 10, as applicable, on the specific service line of the claim.” 97152, 97153, 97154, 97158, 0362T and 0373T carry no telehealth modifier, so technician-delivered treatment is billed as in-person. [3][6]
- **Prior-auth decision time**: Routine PA decisions “within four (4) calendar days following receipt of the request”; urgent within 48 hours; retrospective reviews (requested within 90 days of service) within 30 calendar days of complete information. [3]
- **Other insurance (who pays first)**: CountyCare “is always the payer of last resort.” Bill the primary payer first and include its payment information with the claim. [3][8]

## Delivery and billing rules

Coverage decides whether CountyCare Health Plan (Cook County) pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision**: CountyCare publishes no ABA supervision rule in the documents read. HFS’s rule applies: RBTs “must receive supervision from a BCBA,” with Case Leadership of 5% or more of direct services and two face-to-face contacts a month in HFS’s ABS guidance. [3][5][4]
- **Bill as provider**: CountyCare publishes no ABA-specific rule, so HFS’s applies: rendering BCBA or RBT by name and NPI; for RBT services the supervising BCBA’s name and NPI in Loop 2310D, NM1; all renderers enrolled in IMPACT. [3][4][5]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not addressed by CountyCare; HFS publishes no rule beyond NCCI edits. [3][6]
  - Ask the plan: CountyCare Provider Services, 312-864-8200, or your Provider Relations representative.
- **Daily limits / MUEs** _(ask the plan)_: CountyCare publishes no ABA unit limits; authorized units come from PA. HFS’s fee schedule daily maximums (97153 32 units, 97155 24) are the state benchmark. [3][6]
  - Ask the plan: CountyCare Medical Management, 312-864-8200: ask how ABA units are authorized.
- **Session-note signature** _(ask the plan)_: Not addressed in the CountyCare documents read. [3]
  - Ask the plan: CountyCare Provider Relations (countycareproviderservices@cookcountyhhs.org).
- **Place of service** _(ask the plan)_: No CountyCare ABA setting rule was found. HFS limits remote ABS to 97151, 97155, 97156 and 97157 with GT/93 and POS 02 or 10. [3][6]
  - Ask the plan: CountyCare Provider Services, 312-864-8200.

## What intake should collect for CountyCare Health Plan (Cook County)

- **Member ID and county:** CountyCare serves Cook County only; confirm enrollment on the date of service.
- **Comprehensive Diagnostic Evaluation:** HFS standard: physician or clinical psychologist, with ADOS, GARS, ADI or CARS.
- **Physician order:** HFS requires a physician order for ABS, valid one year.
- **Prior treatment:** Members treated in the last 90 days can keep their provider for 90 days while they transition.
- **Other insurance:** CountyCare pays last; bill the primary first.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Common questions

### Does CountyCare require prior authorization for ABA?

Not for the assessment: 97151 and 97152 have needed no PA since January 1, 2026. ABA treatment still requires prior authorization.

### How fast does CountyCare decide an ABA request?

Routine requests within 4 calendar days, urgent within 48 hours, per its provider manual.

### What is CountyCare’s timely filing limit?

180 calendar days from the date of service; disputes within 60 days of the EOP.

### Who can enroll in CountyCare?

CountyCare is the HealthChoice Illinois plan for Cook County only, per HFS’s managed care map.

## Primary sources

1. [305 ILCS 5/5-30.1 — Illinois Public Aid Code, managed care protections, subsection (g) Timely payment of claims (official text through P.A. 104-470, eff. 6-16-26; read via witnessslips.ilga.gov mirror)](https://witnessslips.ilga.gov/legislation/ilcs/documents/030500050K5-30.1.htm)
2. [CountyCare — Removal of Authorization Requirements for ABA Assessments, eff. January 1, 2026 (notice, February 2026)](https://countycare.com/wp-content/uploads/CCHHS_Provider_Notice_ABA_Feb2026.pdf)
3. [CountyCare — Provider Manual (January 2025)](https://countycare.com/wp-content/uploads/2025-Provider-Manual-011425-2.pdf)
4. [HFS Provider Notice (09/30/2021) — Update to Coverage of Adaptive Behavior Support Services for Children with ASD (eff. 10/1/2021)](https://hfs.illinois.gov/medicalproviders/notices/notice.prn210930b.html)
5. [HFS Provider Notice (08/24/2023) — Updates to ABS Service Provider Qualifications per Public Act 103-0102](https://hfs.illinois.gov/medicalproviders/notices/notice.prn230824a.html)
6. [HFS — Adaptive Behavior Support (ABS) Services Fee Schedule, effective 01/15/2022, updated 05/14/2026](https://hfs.illinois.gov/content/dam/soi/en/web/hfs/medicalproviders/medicaidreimbursement/adaptive/UpdatedABSFeeSchedule51426.pdf)
7. [HFS — Medicaid Managed Care Program Map (January 1, 2026)](https://hfs.illinois.gov/content/dam/soi/en/web/hfs/medicalproviders/cc/documents/managedcaremap.pdf)
8. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)
9. [42 CFR 438.210(d) — Medicaid managed care authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-D/section-438.210)
10. [IDFPR — Behavior Analysts (Licensed Behavior Analyst, Licensed Assistant Behavior Analyst; 225 ILCS 6/150 notice)](https://idfpr.illinois.gov/profs/behavior-analysts.html)
11. [CountyCare Health Plan — Provider Notices](https://countycare.com/provider-notices/)
12. [CountyCare Health Plan — Provider Newsletters](https://countycare.com/providers/provider-newsletters/)
13. [Public Act 104-0028 (HB 3019), eff. Jan. 1, 2026 — official text (read via witnessslips.ilga.gov mirror)](https://witnessslips.ilga.gov/legislation/publicacts/104/104-0028.htm)
14. [215 ILCS 5/370c — Mental and emotional disorders (official ILCS text incl. subsection (w), eff. 1/1/2026; read via witnessslips.ilga.gov mirror)](https://witnessslips.ilga.gov/legislation/ilcs/documents/021500050K370c.htm)
15. [Molina Healthcare of Illinois — Provider Memo: Prior Auth Change for Applied Behavioral Analysis (Jan. 22, 2026)](https://myhealthinhand.molinahealthcare.com/-/media/Molina/PublicWebsite/PDF/Providers/il/2026-Provider-Memos/MHIL_Provider_Memo_Applied_Behavioral_Analysis_Initial_PA_Final508.pdf)
16. [Aetna Better Health of Illinois — Utilization Management changes to align with new legislation (Public Act 104-0028), Feb. 20, 2026](https://es.aetnabetterhealth.com/content/dam/aetna/medicaid/illinois/providers/pdf/ABHIL_UM%20updates_02.20.2026.pdf)
17. [BCBSIL — Medicaid Service Authorization Program Details and Notification Requirements (eff. Jan. 1, 2026, updated March 2026)](https://www.bcbsil.com/docs/provider/il/claims/um/bcchp-pa-summary.pdf)
18. [Meridian — Notification requirements for ABA assessments (02/26/26; eff. May 1, 2026)](https://www.ilmeridian.com/newsroom/notification-requirements-for-applied-behavior-analysis--aba--as.html)
19. [HFS Provider Notice (10/30/2020) — Coverage for ABA Services for Children 0 through 20 Years: Provider Enrollment](https://hfs.illinois.gov/medicalproviders/notices/notice.prn201030c.html)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.