Bill Text: IL HB1085 | 2025-2026 | 104th General Assembly | Enrolled

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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]

Download: Illinois-2025-HB1085-Enrolled.html

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HB1085 Enrolled LRB104 05991 BAB 16024 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Counties Code is amended by changing
Section 5-1069.3 as follows:
(55 ILCS 5/5-1069.3)
Sec. 5-1069.3. Required health benefits. If a county,
including a home rule county, is a self-insurer for purposes
of providing health insurance coverage for its employees, the
coverage shall include coverage for the post-mastectomy care
benefits required to be covered by a policy of accident and
health insurance under Section 356t and the coverage required
under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u,
356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33, 356z.36,
356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61,
356z.62, 356z.64, 356z.67, 356z.68, and 356z.70, and 356z.71,
356z.74, and 356z.77 of the Illinois Insurance Code. The
coverage shall comply with Sections 155.22a, 355b, 356z.19,
and 370c, and 370c.4 of the Illinois Insurance Code. The
Department of Insurance shall enforce the requirements of this

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Section. The requirement that health benefits be covered as
provided in this Section is an exclusive power and function of
the State and is a denial and limitation under Article VII,
Section 6, subsection (h) of the Illinois Constitution. A home
rule county to which this Section applies must comply with
every provision of this Section.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-914,
eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25;
revised 11-26-24.)
Section 10. The Illinois Municipal Code is amended by
changing Section 10-4-2.3 as follows:

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(65 ILCS 5/10-4-2.3)
Sec. 10-4-2.3. Required health benefits. If a
municipality, including a home rule municipality, is a
self-insurer for purposes of providing health insurance
coverage for its employees, the coverage shall include
coverage for the post-mastectomy care benefits required to be
covered by a policy of accident and health insurance under
Section 356t and the coverage required under Sections 356g,
356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x,
356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
356z.29, 356z.30, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
356z.67, 356z.68, and 356z.70, and 356z.71, 356z.74, and
356z.77 of the Illinois Insurance Code. The coverage shall
comply with Sections 155.22a, 355b, 356z.19, and 370c, and
370c.4 of the Illinois Insurance Code. The Department of
Insurance shall enforce the requirements of this Section. The
requirement that health benefits be covered as provided in
this is an exclusive power and function of the State and is a
denial and limitation under Article VII, Section 6, subsection
(h) of the Illinois Constitution. A home rule municipality to
which this Section applies must comply with every provision of
this Section.

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Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-914,
eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25;
revised 11-26-24.)
Section 15. The School Code is amended by changing Section
10-22.3f as follows:
(105 ILCS 5/10-22.3f)
Sec. 10-22.3f. Required health benefits. Insurance
protection and benefits for employees shall provide the
post-mastectomy care benefits required to be covered by a
policy of accident and health insurance under Section 356t and

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the coverage required under Sections 356g, 356g.5, 356g.5-1,
356m, 356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a,
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14,
356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
356z.61, 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70, and
356z.71, 356z.74, and 356z.77 of the Illinois Insurance Code.
Insurance policies shall comply with Section 356z.19 of the
Illinois Insurance Code. The coverage shall comply with
Sections 155.22a, 355b, and 370c, and 370c.4 of the Illinois
Insurance Code. The Department of Insurance shall enforce the
requirements of this Section.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;

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103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718, eff.
7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25; 103-918,
eff. 1-1-25; 103-1024, eff. 1-1-25; revised 11-26-24.)
Section 20. The Illinois Insurance Code is amended by
adding Section 370c.4 as follows:
(215 ILCS 5/370c.4 new)
Sec. 370c.4. Mental health and substance use parity.
(a) In this Section:
"Application" means a person's or facility's application
to become a participating provider with an insurer in at least
one of the insurer's provider networks.
"Applying provider" means a provider or facility that has
submitted a completed application to become a participating
provider or facility with an insurer.
"Behavioral health trainee" means any person: (1) engaged
in the provision of mental health or substance use disorder
clinical services as part of that person's supervised course
of study while enrolled in a master's or doctoral psychology,
social work, counseling, or marriage or family therapy program
or as a postdoctoral graduate working toward licensure; and
(2) who is working toward clinical State licensure under the
clinical supervision of a fully licensed mental health or
substance use disorder treatment provider.
"Completed application" means a person's or facility's

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application to become a participating provider that has been
submitted to the insurer and includes all the required
information for the application to be considered by the
insurer according to the insurer's policies and procedures for
verifying a provider's or facility's credentials.
"Contracting process" means the process by which a mental
health or substance use disorder treatment provider or
facility makes a completed application with an insurer to
become a participating provider with the insurer until the
effective date of a final contract between the provider or
facility and the insurer. "Contracting process" includes the
process of verifying a provider's credentials.
"Participating provider" means any mental health or
substance use disorder treatment provider that has a contract
to provide mental health or substance use disorder services
with an insurer.
(b) Consistent with the principles of the federal Mental
Health Parity and Addiction Equity Act of 2008, and for the
purposes of strengthening network adequacy for mental health
and substance use disorder services and lowering
out-of-network utilization, provider reimbursement rates
subject to this Section shall comply with the reimbursement
rate floors for all in-network mental health and substance use
disorder services, including inpatient services, outpatient
services, office visits, and residential care, delivered by
Illinois providers and facilities using the Illinois data in

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the Research Triangle Institute International's study,
Behavioral Health Parity - Pervasive Disparities in Access to
In-Network Care Continue, Mark, T.L., & Parish, W. (April
2024). The reimbursement rate floors for in-network mental
health and substance use disorder services requires that
reimbursement for each service, classified by Healthcare
Common Procedure Coding System (HCPCS) codes, Current
Procedural Terminology (CPT) codes, Ambulatory Payment
Classifications (APC), Enhanced Ambulatory Patient Groups
(EAPG), Medicare Severity Diagnosis Related Groups (MS-DRG),
All Patient Refined Diagnosis Related Groups (APR-DRG), and
base payment rates with adjusters and applicable outliers must
be equal to or greater than the dollar amounts applicable
under this subsection on the date of service for the
geographic location. 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 shall
apply to all group or individual policies of accident and
health insurance or managed care plans that are amended,
delivered, issued, or renewed on or after January 1, 2027, or
any contracted third party administering the behavioral health
benefits for the insurer.

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(1) Except as otherwise provided in this subsection,
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 shall be
equal to the following dollar amount:
(A)(i) the average reimbursement percentage for
Illinois All Medical/Surgical Clinicians, as listed on
the first line of Appendix C-13, page C-52 of the
Research Triangle Institute International study, plus;
(ii) half of the difference between the
average reimbursement percentage and the
percentage at the 75th percentile for Illinois All
Medical/Surgical Clinicians, as listed in the
first line in Appendix C-13, page C-52, multiplied
by;
(B) the same source of the benchmark rate that was
used to calculate the percentages in items (i) and
(ii) of subparagraph (A), using the updated benchmark
rate for medical/surgical clinicians for the same
Healthcare Common Procedure Coding System (HCPCS) or
Current Procedural Terminology (CPT) code in effect on

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the date of service for the geographic location,
except that:
(i) the source of the benchmark rate for a
hospital inpatient service shall follow the
formula set out by the same federal health care
program for the acute inpatient operating
prospective payment system in effect on the date
of service for the geographic location using all
applicable adjusters and outliers; and
(ii) the source of the benchmark rate for a
hospital outpatient service shall follow the
formula set out by the same federal health care
program for the hospital outpatient services
prospective payment system in effect on the date
of service for the geographic location using all
applicable adjusters and outliers.
Calculation of the benchmark rate shall adhere to
the methodologies used in the Research Triangle
Institution International study using comparable
benefits within the same classification.
(2) If the rate benchmark set by this subsection is
tied to a federal health care program, a rate floor dollar
amount shall take effect on the date the federal health
care program's benchmark rate takes effect. However, for
any year that the benchmark rate decreases for any
Healthcare Common Procedure Coding System (HCPCS) code,

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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, the reimbursement rate floor for the
purposes of this Section shall remain at the level it was
the previous year. Notwithstanding any other provision of
this Section, all rate floor dollar amounts in effect on
January 1, 2027 shall be equal to the amount described in
paragraph (1). The Department has the authority to enforce
and monitor the reimbursement rate floor set pursuant to
this Section.
(c) 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.
(d) 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

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benefits for the insurer, shall cover any medically necessary
mental health or substance use disorder service provided by a
behavioral health trainee when the trainee is working toward
clinical State licensure and is under the supervision of a
fully licensed mental health or substance use disorder
treatment provider who is a physician licensed to practice
medicine in all its branches, licensed clinical psychologist,
licensed clinical social worker, licensed clinical
professional counselor, licensed marriage and family
therapist, licensed speech-language pathologist, or other
licensed or certified professional at a program licensed
pursuant to the Substance Use Disorder Act who is engaged in
treating mental, emotional, nervous, or substance use
disorders or conditions. Services provided by the trainee must
be billed under the supervising clinician's rendering National
Provider Identifier.
(e) 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:
(1) cover medically necessary 60-minute psychotherapy
billed using the Current Procedural Terminology Code 90837
for Individual Therapy;
(2) not impose more onerous documentation requirements
on the provider than is required for other psychotherapy

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Current Procedural Terminology (CPT) codes; and
(3) not audit the use of Current Procedural
Terminology Code 90837 any more frequently than audits for
the use of other psychotherapy Current Procedural
Terminology (CPT) codes.
(f)(1) Any 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 complete the contracting
process with a mental health or substance use disorder
treatment provider or facility for becoming a participating
provider in the insurer's network, including the verification
of the provider's credentials, within 60 days from the date of
a completed application to the insurer to become a
participating provider. Nothing in this paragraph (1),
however, presumes or establishes a contract between an insurer
and a provider.
(2) Any 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 reimburse a participating
mental health or substance use disorder treatment provider or
facility at the contracted reimbursement rate for any
medically necessary services provided to an insured from the

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date of submission of the provider's or facility's completed
application to become a participating provider with the
insurer up to the effective date of the provider's contract.
The provider's claims for such services shall be reimbursed
only when submitted after the effective date of the provider's
contract with the insurer. This paragraph (2) does not apply
to a provider that does not have a completed contract with an
insurer. If a provider opts to submit claims for medically
necessary mental health or substance use disorder services
pursuant to this paragraph (2), the provider must notify the
insured following submission of the claims to the insurer that
the services provided to the insured may be treated as
in-network services.
(3) Any 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 any medically necessary
mental health or substance use disorder service provided by a
fully licensed mental health or substance use disorder
treatment provider affiliated with a mental health or
substance use disorder treatment group practice who has
submitted a completed application to become a participating
provider with an insurer who is delivering services under the
supervision of another fully licensed participating mental
health or substance use disorder treatment provider within the

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same group practice up to the effective date of the applying
provider's contract with the insurer as a participating
provider. Services provided by the applying provider must be
billed under the supervising licensed provider's rendering
National Provider Identifier.
(4) Upon request, an insurer, or any contracted third
party administering the behavioral health benefits for the
insurer, shall provide an applying provider with the insurer's
credentialing policies and procedures. An insurer, or any
contracted third party administering the behavioral health
benefits for the insurer, shall post the following
nonproprietary information on its website and make that
information available to all applicants:
(A) a list of the information required to be included
in an application;
(B) a checklist of the materials that must be
submitted in the credentialing process; and
(C) designated contact information of a network
representative, including a designated point of contact,
an email address, and a telephone number, to which an
applicant may address any credentialing inquiries.
(g) The Department has the same authority to enforce this
Section as it has to enforce compliance with Sections 370c and
370c.1. Additionally, if the Department determines that an
insurer or any contracted third party administering the
behavioral health benefits for the insurer has violated this

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Section, the Department shall, after appropriate notice and
opportunity for hearing in accordance with Section 402, by
order assess a civil penalty of $1,000 for each violation. The
Department shall establish any processes or procedures
necessary to monitor compliance with this Section.
(h) At the end of 2 years, 7 years, and 12 years following
the implementation of subsection (b) of this Section, the
Department shall review the impact of this Section on network
adequacy for mental health and substance use disorder
treatment and access to affordable mental health and substance
use care. By no later than December 31, 2030, December 31,
2035, and December 31, 2040, the Department shall submit a
report in each of those years to the General Assembly that
includes its analyses and findings. For the purpose of
evaluating trends in network adequacy, the Department is
granted the authority to examine out-of-network utilization
and out-of-pocket costs for insureds for mental health and
substance use disorder treatment and services for all plans to
compare with in-network utilization for purposes of evaluating
access to care. The Department shall conduct an analysis of
the impact, if any, of the reimbursement rate floor for mental
health and substance use disorder services on health insurance
premiums across the State-regulated health insurance markets,
taking into consideration the need to expand network adequacy
to improve access to care.
(i) The Department of Insurance shall adopt any rules

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necessary to implement this Section by no later than September
1, 2026.
(j) This Section does not apply to a health care plan
serving Medicaid populations that provides, arranges for, pays
for, or reimburses the cost of any health care service for
persons who are enrolled under the Illinois Public Aid Code or
under the Children's Health Insurance Program Act.
Section 99. Effective date. This Act takes effect June 1,
2026.