It may soon be easier for Illinois residents to find therapists who accept their insurance, after Gov. JB Pritzker signed a bill into law Friday taking aim at insurance reimbursement rates for behavioral health services.

The new law, which will take full effect in January 2027, creates a formula outlining how much insurers must pay therapists for their services. It also aims to cut red tape that many therapists say has put them off working with insurers.

In recent years, many therapists have stopped taking private insurance because of what they describe as low and stagnant reimbursement rates from insurers. That’s made it difficult for patients to find therapists who take their insurance, leading many patients to either skip therapy or pay entirely out-of-pocket.

“This means that patients will have more choices on where to use their private insurance for the full spectrum of behavioral health, and they won’t be put in situations where they’ll either have to pay out-of-pocket or forgo care all together,” said bill sponsor Rep. Lindsey LaPointe, D-Chicago.

Not only will the new law address reimbursement rates, but it will also bar insurers from requiring therapists to submit more documentation for 60-minute sessions versus shortage ones; it will require insurers to cover multiple behavioral health services for an individual patient in one day; and it will require insurers to cover services provided by therapists in training who are supervised by licensed professionals. The new law also aims to shorten the time it takes for therapists to become in-network with insurers.

The bill passed the legislature in October over the objections of insurance industry representatives who expressed concern about the precedent of setting reimbursement rates in statute, and who said higher reimbursement rates could mean higher costs for other consumers.

Insurance industry group AHIP said in a statement in recent weeks that it would continue to work with policymakers “to advance solutions that improve affordability and access to mental health and substance abuse care.”

The new law will apply to about 2.5 million people in Illinois who have state-regulated health insurance plans, LaPointe said. Large companies typically have self-funded plans, which are regulated by the federal government, not the state.

The law also will not apply to people with HMOs. And it will not apply to state employees, who were carved out of the bill over concerns that it could raise costs for the state — an argument that LaPointe disputes.

LaPointe and advocates from Thresholds began working on the measure several years ago. Thresholds serves people with serious mental health and substance use disorders in Illinois.

Under previous versions of the bill, insurers would have had to pay in-network therapists 141% of what Medicare pays for therapy and substance use disorder services. The version of the bill that passed this fall does not include that 141% figure, but instead has a formula that should get reimbursements to the “ballpark” of 141% of Medicare reimbursements, LaPointe said.

“After three years of work it’s validating that Illinois is finally taking this step which is so fundamental to access to care, to bringing more behavioral health providers into networks,” LaPointe said. “This bill is a very concrete thing to do to make health care more affordable to people, and we’re doing it at a time when Medicaid is under threat and affordability through the (Affordable Care Act) marketplace is under threat, so this bill couldn’t come soon enough.”

Allison Staiger, a licensed clinical social worker who has a solo practice in Ravenswood, said the bill “will really be helpful for the day-to-day sustainability of therapists’ livelihood.”

Staiger noted that there’s more work to be done when it comes to making it easier for therapists and other health care providers to work with insurers.

“I think this is a step in the right direction for fair pay for therapists and our field being valued more than it is,” Staiger said.

https://www.chicagotribune.com/2025/12/12/therapists-insurance-prizker-bill/