SPECIALIZED THERAPIES SERVICES PROVIDER IN ILLINOIS

SUPPORTING RECOVERY, FUNCTIONAL IMPROVEMENT, AND INDEPENDENT LIVING THROUGH THERAPEUTIC INTERVENTIONS

Specialized Therapies Services in Illinois provide habilitative, rehabilitative, and restorative therapy to individuals with developmental disabilities, brain injuries, physical impairments, and chronic conditions. These services are authorized under Illinois Medicaid Home and Community-Based Services (HCBS) Waiver programs and the Medicaid State Plan to promote functional gains, health improvement, and greater community participation.

​​1. GOVERNING AGENCIES

Agency: Illinois Department of Healthcare and Family Services (HFS)

Role: Administers Medicaid funding for Specialized Therapies, oversees provider enrollment, service authorization, and reimbursement

Agency: Illinois Department of Human Services (DHS) — Division of Developmental Disabilities (DDD) and Division of Rehabilitation Services (DRS)

Role: Coordinates eligibility, care planning, therapy approvals, and quality assurance for waiver participants

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight ensuring Specialized Therapies meet Medicaid HCBS quality standards, person-centered care requirements, and habilitative/rehabilitative definitions

2. SPECIALIZED THERAPIES SERVICE OVERVIEW

Specialized Therapies include medically necessary or developmentally supportive therapy services delivered under a plan of care to enhance functional abilities and promote independence.

Approved providers may deliver:

• Physical therapy (PT): Improving mobility, balance, strength, and pain management

• Occupational therapy (OT): Enhancing self-care skills, sensory integration, and environmental adaptations

• Speech-language pathology (SLP): Addressing communication impairments, swallowing disorders (dysphagia), and cognitive-communication deficits

• Behavioral therapies: Supporting individuals with emotional, behavioral, or social challenges through applied behavior analysis (ABA) or counseling-based models

• Respiratory therapy: Managing pulmonary conditions and promoting respiratory health (limited use based on waiver program)

Therapies must be authorized in the participant’s Individualized Service Plan (ISP) or Plan of Care (POC) based on assessed needs and must follow HCBS and State Plan requirements.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business entity with the Illinois Secretary of State

• Obtain EIN from the IRS and NPI (Type 2)

• Enroll as a Medicaid Waiver provider through the Illinois Medicaid Provider Enrollment Portal (IMPACT system)

• Hold active Illinois licensure for each therapy discipline (PT, OT, SLP, Behavioral Therapists)

• Maintain general liability and professional malpractice insurance

• Develop clinical policies for therapy assessment, intervention planning, participant safety, and documentation

• Ensure staff meet licensing, credentialing, background checks, and continuing education requirements

4. ILLINOIS PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Submit Provider Enrollment Application through the IMPACT system for Specialized Therapies under appropriate waiver programs or State Plan services

Application and Documentation Submission:

• Provide Articles of Incorporation, EIN/NPI verification, professional licensure documents, insurance certificates, operational policies, and therapist credentialing records

Program Readiness Review:

• DHS and/or HFS review service delivery models, therapist qualifications, clinical record-keeping procedures, participant-centered service standards, and billing readiness

Approval & Medicaid Enrollment:

• Upon approval, providers are authorized to deliver specialized therapy services and bill Medicaid for approved services (therapy evaluation, re-evaluation, and ongoing therapy sessions)

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License (Illinois Secretary of State)

• IRS EIN confirmation

• NPI confirmation

• Illinois Professional Licenses for each therapy discipline

• Proof of professional liability and general liability insurance

• Specialized Therapies Policy & Procedure Manual including:

  • Participant intake, therapy assessment, and plan of care development procedures

  • Documentation and tracking of therapy services and participant progress

  • Incident reporting, participant rights, HIPAA confidentiality procedures

  • Staff credentialing, licensure verification, training records, and competency assessments

  • Billing practices for Medicaid audits and service documentation standards

6. STAFFING REQUIREMENTS

Role: Clinical Supervisor/Therapy Services Director

Requirements: Licensed therapist (PT, OT, SLP, or Behavior Analyst) with supervisory experience; background clearance

Role: Licensed Therapists (PTs, OTs, SLPs, Behavior Analysts)

Requirements: Active Illinois licensure in relevant discipline; CPR certification preferred; continuing education as required by licensing board; background screening clearance

Role: Therapy Assistants (where permitted)

Requirements: Licensed Physical Therapist Assistant (PTA) or Certified Occupational Therapy Assistant (COTA); supervised by licensed therapists; background clearance

All staff must complete:

• HCBS Settings Rule and participant-centered service delivery training

• HIPAA compliance and confidentiality training

• Abuse, neglect, and exploitation prevention training

• Infection control, emergency preparedness, and participant safety training

• Annual clinical competency evaluations and ongoing professional development

7. MEDICAID WAIVER PROGRAMS

Specialized Therapies are available under the following Illinois Medicaid programs:

• Adults with Developmental Disabilities Waiver

• Children and Young Adults with Developmental Disabilities Waiver

• Persons with Brain Injury (BI) Waiver

• Persons with Disabilities (PD) Waiver

• Elderly Waiver (Community Care Program) — limited therapy services under CCP case management

Approved providers may deliver:

• Evaluation and re-evaluation services

• Direct therapy intervention sessions

• Participant and caregiver training for carryover activities

• Ongoing reassessment to adjust therapy goals and service plans

• Coordination with case managers, primary care physicians, and interdisciplinary teams

8. TIMELINE TO LAUNCH

Phase: Business Formation and Professional Compliance Preparation

Timeline: 1–2 months

Phase: Staff Hiring, Credentialing, and Therapy Program Development

Timeline: 2–3 months

Phase: IMPACT Medicaid Provider Enrollment and Readiness Review

Timeline: 60–90 days

Phase: Medicaid Billing System Setup and Specialized Therapies Service Launch

Timeline: 30–45 days

9. CONTACT INFORMATION

Illinois Department of Healthcare and Family Services (HFS)

Website: https://www.hfs.illinois.gov/

Illinois Department of Human Services (DHS) — Division of Developmental Disabilities and Division of Rehabilitation Services

Website: https://www.dhs.state.il.us/

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov/

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — ILLINOIS SPECIALIZED THERAPIES PROVIDER

WCG assists therapy service providers, rehabilitation centers, and interdisciplinary care teams in launching Medicaid-compliant Specialized Therapy Services across Illinois.​​​​​​​​​​​​​​​​​​​

Scope of Work:

• Business registration, Medicaid enrollment, and clinical compliance guidance

• Development of Specialized Therapies Policy & Procedure Manual

• Staff credentialing templates, therapy assessment forms, and participant tracking systems

• Medicaid billing system setup and audit-ready claims management

• Website, domain, and professional branding support

• Therapy intervention protocols, care plan templates, and outcome tracking tools

• Quality assurance programs for clinical supervision, documentation audits, and participant satisfaction

• Referral and care coordination partnership development with hospitals, schools, and community agencies

Continue To Our Client Portal To Get Started

Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.