Comments: IL HB1085 | 2025-2026 | 104th General Assembly

Illinois House Bill 1085

Bill Title: Amends the Illinois Insurance Code. In provisions concerning mental health and substance use parity, makes changes to defined terms. Requires specified provider reimbursement rates to comply with the reimbursement floors for all in-network mental health and substance use disorder services. Establishes the reimbursement rate floor for each Healthcare Common Procedure Coding System (HCPCS) code, Current Procedural Terminology (CPT) code, Ambulatory Payment Classification (APC), Enhanced Ambulatory Patient Group (EAPG), Medicare Severity Diagnosis Related Group (MS-DRG), All Patient Refined Diagnosis Related Group (APR-DRG), and base payment rate with adjusters and applicable outliers for a mental health or substance use disorder service. Provides that a group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2027, or any contracted third party administering the behavioral health benefits for the insurer, shall cover all medically necessary mental health or substance use disorder services received by the same insured on the same day from the same or different mental health or substance use provider or facility for both outpatient and inpatient care. Sets forth provisions concerning additional coverage requirements; disclosure provisions; and provisions concerning the Department of Insurance's enforcement authority, reporting requirements, and rulemaking. Makes other changes. Amends the Counties Code, the Illinois Municipal Code, and the School Code to require coverage under the provisions of those Acts. Effective June 1, 2026.

Sponsorship: Strong Partisan Bill (Democrat 85-5)

Status: (Passed) 2025-12-12 - Public Act . . . . . . . . . 104-0446 [HB1085 Detail]

Text: Latest bill text (Enrolled) [HTML]