“This law is about what insurance needs to do.” ~Rose Metivier
How Illinois HB1085 could change therapist reimbursement, what group practice owners need to know, and why advocacy matters.
I’ve been deep in the Facebook therapist groups lately and…y’all! I’m a bit taken aback by how many freak-outs are happening around IL HB1085. When it goes into effect on January 1st, 2027, HB1085 will upend decades of anemic insurance reimbursement rates––higher payouts, huzzah!––with a few exceptions.
And here’s more good news: group practice owners don’t need to do anything to “prepare.” You don’t need to install an app or buy coursework to benefit from the law. You should, however, be informed. That’s where my chat with Rose Metivier, LCPC, comes in.
If you’re a practitioner located outside of Illinois, I urge you to stick around anyway. Sure, we'll cover the details of HB1085 and how it will affect the state’s group practice owners. But Rose’s connection to the legislation also provides a primer on how you can start advocating for policy changes in your town, city, or state.
“I want [clinicians] to be armed with information so that they know what they should be getting,” says Rose of the sweeping changes headed our way. “Worst case scenario is that things are the same. This isn't anything that's gonna take away your money, or be bad for a practice. It can only be good. We just don't know how good.”
Here’s what’s included in HB1085:
A minimum reimbursement rate floor
Same-day coverage for different services
Billing for trainee services under the supervising clinician's NPI
Documentation and audit limits (I.E. not getting flagged for overuse of CPT #90837)
Shortened timeline to become an in-network provider and retroactive reimbursement to date of completed application
“This isn't winning the lottery,” Rose cautions. “But it's really good.” While the bill has already been codified (arranging the pieces into a systematic code), insurance companies are working to minimize its effects on their bottom lines. Rose recommends that practice owners keep the Illinois Department of Insurance (IDOI) contact information handy. “The only thing keeping this law honest is our participation and communication with IDOI and filing complaints if insurance companies aren't complying,” she says.
Our liberation hinges on smaller, daily acts of collective action. Rose’s involvement with HB1085 is a blueprint for our profession's future.
Find the HB1085 docs mentioned in this episode here:
Self-Funded Vs Fully-Funded Cheat Sheet
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MENTIONED IN THIS EPISODE
Self-Funded Vs Fully-Funded Cheat Sheet
Star Trek: The Next Generation
IL Representative Lindsey LaPointe
Illinois Department of Insurance (IDOI)
GUEST CONTACT & BIO
Midwest Counseling & Diagnostics
Rose Metivier, LCPC, is Chief Operations Officer at Midwest Counseling & Diagnostics. With 20 years of clinical experience, she continues to work with clients and lead DBT Skills groups, drawing from DBT, EMDR, and Compassion-Focused Therapy. A self-identified nerd, Rose credits Star Trek: The Next Generation and Quantum Leap with helping shape her systems-oriented worldview and her commitment to humility, equity, transparency, compassion, and integrity.
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