Illinois HB 1085: What to Do Before 2027

Last updated: August 18, 2026.

Illinois HB 1085 is now law. The governor approved it on December 12, 2025, it became Public Act 104-0446, and its reimbursement provisions apply to covered plans amended, delivered, issued, or renewed on or after January 1, 2027. Illinois General Assembly.

Most of the coverage so far has focused on the headline number: a reimbursement floor of 141.7% of the Medicare rate for in-network mental health and substance-use services under covered commercial plans. That number matters, and we modeled what it could mean for a therapy practice in our Illinois 90837 rates post.

This post is about the other half of the law: the parts that depend on what your practice does between now and January 2027. The floor is written into statute, but how much of it reaches your practice runs through your payer contracts and your credentialing status. That is the part you can act on this year.

Practice takeaway: the floor does not hand out raises by itself. It applies plan by plan and contract by contract. The practices that benefit most in 2027 will be the ones that know what their contracts say, know their current allowed amounts, and have their credentialing in order before the law kicks in.

TL;DR: What HB 1085 Changes

• A reimbursement floor. Covered commercial plans must reimburse in-network mental health and substance-use services at no less than 141.7% of what Medicare would pay. The floor is set by formula and does not go down if Medicare rates drop. NASW-IL summary.

• A 60-day credentialing clock. Insurers must complete the contracting process, including credential verification, within 60 days of receiving a completed application. IHA memo.

• Retroactive payment for new contracts. Once a contract is finalized, reimbursement reaches back to the date the completed application was received, not the date the contract was signed. IHA memo.

• Limits, too. It applies to state-regulated fully funded commercial plans. Self-insured employer plans, state employee health plans, HMO plans, and Medicaid/MCO plans are not covered. NASW-IL summary.

What the Floor Could Be in Dollars

The floor is expressed against what Medicare would pay, so the arithmetic starts with the Medicare amount for the service. Using the 2026 national non-facility amounts as the benchmark: 90837 (individual psychotherapy, 53 minutes or longer) is about $167.00, and 90791 (psychiatric diagnostic evaluation) is about $173.35. Your own locality amount will differ, and you can look yours up in the CMS Physician Fee Schedule search tool.

Multiplying those by 141.7% gives roughly $236.64 for 90837 and $245.64 for 90791. For a therapist whose covered commercial plans currently allow somewhere in the $95 to $130 range, that is a large gap.

There is a wrinkle worth understanding before you plug your own license into that number, because Medicare itself does not pay every clinician the same amount for the same session. Under the Medicare fee schedule, a clinical psychologist or psychiatrist is paid the full amount, a nurse practitioner or physician assistant is paid 85% of it, and a licensed clinical social worker, marriage and family therapist, or mental health counselor is paid 75% of it.

For 90837, that means Medicare currently pays roughly $167.00 to a psychologist or psychiatrist, $141.95 to an NP or PA, and $125.25 to a masters-level clinician. For 90791 the same differentials give roughly $173.35, $147.35, and $130.01.

So which Medicare number does the 141.7% attach to: the full fee-schedule amount for the service, or the reduced amount Medicare would actually pay that clinician? The Act sets the floor for in-network mental health and substance use disorder services and does not sort clinicians by license type, but it also does not spell out how the provider-type differential interacts with the calculation. Both readings produce very different checks, so here they are side by side.

If the floor is 141.7% of the full fee-schedule amount

Every clinician billing the code gets the same floor, because the floor attaches to the service rather than the license.

• 90837: about $236.64 for a psychologist, psychiatrist, NP, PA, LCSW, LMFT, or LPC alike.

• 90791: about $245.64, again the same across license types.

If the floor tracks the provider-type amount

The percentage is applied to what Medicare would pay that particular clinician, so Medicare’s existing differential carries through into the floor.

• Psychologist or psychiatrist: about $236.64 for 90837 and $245.64 for 90791.

• Nurse practitioner or PA: about $201.14 for 90837 and $208.80 for 90791.

• LCSW, LMFT, or LPC: about $177.48 for 90837 and $184.22 for 90791.

Why this gap matters: for a masters-level clinician, the two readings are about $177 and about $237 for the same 90837 session. Most therapists in Illinois private practice are masters-level, so this is the single detail that most affects what the law is worth to a typical practice. Watch how the Department of Insurance implements it, and ask your payers directly what floor they are applying to your contract.

Treat every figure above as illustrative arithmetic rather than a quoted rate. They use national non-facility benchmarks, not your locality; they assume the 141.7% summary figure rather than recomputing the statute’s underlying formula; and they do not account for setting, geography, or the specifics of your contract.

Who HB 1085 Covers, and Who It Does Not

This is the first thing to check before making any plans around the law, because the most common disappointment will be a plan that turns out not to be covered.

NASW-IL summarizes the scope this way: the law reaches state-regulated fully funded commercial plans. It does not reach self-insured employer plans (the large-employer plans regulated federally under ERISA), state employee health plans, HMO plans, or Medicaid and Medicaid managed-care plans. NASW-IL summary.

A practical consequence: two clients with the same insurance card brand can sit on opposite sides of the line, because one employer self-funds its plan and another buys a fully insured one. Whether a given plan is covered is a plan-level question, not a payer-level one.

Keep Supervision, Network Participation, and Plan Coverage Separate

These are three different questions. A plan being self-funded rather than fully insured changes the plan-level question; it does not answer the other two.

• Clinical supervision: this is the professional and practice relationship between a trainee or clinician and a qualified supervisor. A patient having a self-funded plan does not change whether supervision is required or whether that relationship meets the applicable licensing rules.

• Network participation: this is whether the clinician or group has been credentialed and contracted with the network. It is an important prerequisite, but it is not a promise that every employer plan using that network will process the clinician the same way.

• Plan coverage and billing: this is whether the particular member plan recognizes the clinician and the proposed billing arrangement. Check the member's actual eligibility and benefits, the clinician's network status, and any supervisor or billing requirements before assigning care.

HB 1085 has a specific protection for covered Illinois plans: medically necessary services from a behavioral health trainee working toward clinical State licensure under an eligible fully licensed supervisor must be covered, with the service billed under the supervisor's rendering NPI. That is a covered-plan billing rule, not a change to clinical supervision rules or a blanket credentialing rule for every clinician and plan. Public Act 104-0446.

Practical assignment check: confirm the supervision arrangement first, then network participation, then the specific patient plan's coverage and billing rules. A self-funded plan can affect the third step even when the first two are satisfied.

The 60-Day Credentialing Rule

Credentialing timelines are one of the oldest complaints in Illinois private practice. Applications that sit for four to six months are common enough that we wrote a guide to Illinois credentialing timelines before this law existed.

HB 1085 changes the mechanics in two ways. IHA summarizes them: insurers must complete the contracting process with a behavioral health provider within 60 days of the completed application, including credential verification. And once a contract is finalized, reimbursement is retroactive to the date the completed application was received.

Two cautions on reading that generously. The 60-day clock runs from a completed application, so incomplete submissions restart the argument about when the clock started. And the rule does not presume a contract: both sides still have to finalize one. What the law removes is the open-ended waiting, and what it adds is the retroactive payment window once a contract lands.

Why this favors applying in 2026: a clinician whose application is complete and in the queue when the law takes effect is positioned to benefit from both the shorter clock and the retroactive window, rather than starting the process after the rush.

Why Your Contracts Suddenly Matter

The floor provisions apply to covered plans amended, delivered, issued, or renewed on or after January 1, 2027. Public Act 104-0446. That phrasing puts your contract and plan renewal dates at the center of the timing question: the floor reaches a plan through its issue, amendment, or renewal cycle, not all at once on New Year’s Day.

That is why the practical advice from practice-side commentators has converged on the same short list: know what your current contracts say, know your current allowed amounts, and pay attention to renewal paperwork and amendments between now and 2027. An amendment that arrives in late 2026 deserves a closer read than usual.

A surprising number of practices cannot do step one, because they do not have copies of their payer contracts. That is normal, not negligent: contracts get signed in an online portal years ago, the practice changes EHRs or owners, and the PDF never lands anywhere durable. If that is you, the fix is straightforward: the payer has the contract, and you (or your biller) can request a copy from each network you participate in.

What to Do Before January 2027

1. Get copies of your payer contracts. Request one from each payer you participate with. You want the rate exhibit or fee schedule, the renewal and amendment terms, and the notice windows.

2. Track your allowed amounts. Not what the plan paid after cost-sharing: the allowed amount, per CPT code, per payer. That is the number the floor gets compared against. Our 90837 rates post walks through the math with worked examples.

3. Note your renewal dates. The floor reaches a plan when it is issued, amended, or renewed on or after January 1, 2027, so your contract and plan cycle determines when the change can actually show up.

4. Start credentialing you have been putting off. The 60-day clock and retroactive payment window make a completed 2026 application more valuable than the same application filed mid-2027.

5. Read late-2026 payer amendments carefully. Renewal paperwork and amendments in the run-up to the effective date are where the floor either lands in your contract terms or gets deferred by another cycle.

How Bomi Handles This for Its Practices

For practices we bill and credential for, this list is work we do rather than homework we assign. We track which networks each practice and clinician participates in, we can request contract copies from payers on the practice’s behalf, we track allowed amounts from remittances as a matter of course, and credentialing applications are our paperwork to complete and chase. If you run an Illinois practice and want this handled, that is what we do.

Frequently Asked Questions

What is Illinois HB 1085?

HB 1085 is an Illinois law, now Public Act 104-0446, signed December 12, 2025. For covered commercial plans it sets a reimbursement floor of 141.7% of the Medicare rate for in-network mental health and substance-use services, requires insurers to complete provider contracting within 60 days of a completed application, and makes reimbursement retroactive to the application date once a contract is finalized.

When does HB 1085 take effect?

The act has an effective date of June 1, 2026, and its reimbursement-floor provisions apply to covered plans amended, delivered, issued, or renewed on or after January 1, 2027. Because the floor reaches a plan through its issue, amendment, or renewal cycle, the change arrives plan by plan rather than all at once.

Does HB 1085 apply to self-funded employer plans?

No. Per NASW-IL, the law covers state-regulated fully funded commercial plans. Self-insured employer plans, state employee health plans, HMO plans, and Medicaid/MCO plans are not covered. Whether a specific plan is covered is a plan-level question, not a payer-level one.

Does a self-funded plan change clinical supervision rules?

No. Clinical supervision is a professional and practice responsibility, not a feature of the patient's funding arrangement. The plan type can still affect whether the specific plan recognizes the clinician and billing arrangement. For state-regulated plans covered by HB 1085, the Act includes a separate rule for certain behavioral health trainees working toward licensure under an eligible supervisor; it does not create a blanket credentialing right for every clinician or plan.

If a clinician is in a network, can they see every patient with that insurance brand?

Not automatically. Credentialing and network participation are separate from a member plan's benefits and billing rules. Confirm the specific patient plan's eligibility and benefits, the clinician's network status, and any supervisor or billing requirements before assigning care—especially when an employer self-funds a plan administered by a familiar insurance brand.

What is the 60-day credentialing requirement?

Insurers must complete the contracting process with a behavioral health provider, including credential verification, within 60 days of receiving a completed application. The rule does not presume a contract will be signed, but once one is finalized, reimbursement is retroactive to the date the completed application was received.

Do I need copies of my payer contracts?

It is worth having them. The floor interacts with your contract terms and renewal cycle, so knowing what your contracts say and when they renew is the starting point for 2027 planning. If you do not have copies, the payer does, and you or your biller can request one from each network you participate in.

How much is the HB 1085 floor in dollars for 90837?

Using the 2026 national non-facility Medicare amount of about $167.00 for 90837, 141.7% works out to roughly $236.64. If the floor instead tracks what Medicare would pay that specific clinician, a nurse practitioner would be around $201.14 and a masters-level clinician (LCSW, LMFT, LPC) around $177.48, because Medicare pays those clinicians 85% and 75% of the fee schedule respectively. The Act does not sort clinicians by license type, so which reading applies is worth confirming with your payer. Your locality amount will also differ from the national benchmark.

Does the floor pay masters-level therapists less than psychologists?

It is unresolved. Medicare itself pays a licensed clinical social worker, MFT, or mental health counselor 75% of what it pays a psychologist or psychiatrist for the same session, and an NP or PA 85%. HB 1085 sets its floor for in-network mental health and substance use disorder services without sorting clinicians by license. For a 90837 session that difference is roughly $177 versus $237, so it materially changes what the law is worth to a masters-level practice.

Will my rates go up automatically in 2027?

Not automatically. The floor applies to covered plans as they are issued, amended, or renewed on or after January 1, 2027, and actual impact depends on the plan type, your contract, the service and code, and implementation details. Practices that know their current allowed amounts will be in the best position to spot and pursue the difference.

Sources

• Illinois General Assembly bill status for HB 1085

• Illinois General Assembly Public Act 104-0446

• NASW-IL summary of HB 1085

• CMS Physician Fee Schedule search tool

• Illinois Health and Hospital Association memo on the behavioral health insurance reform package