Illinois HB 1085: What to Do Before 2027
By Dax Earl • August 14, 2026
Last updated: August 14, 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.
Sections
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.
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
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.
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.
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.
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.
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.
Sources
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