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Wisconsin Legislature: AB1127: Bill Text
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AB1127: Bill Text
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2025 - 2026 LEGISLATURE
LRB-1301/1
JPC/MDE/SWB:emw
2025 ASSEMBLY BILL 1127
March 13, 2026 - Introduced by Representatives
Anderson
,
Andraca
,
Bare
,
Clancy
,
Joers
,
Miresse
,
Palmeri
,
Sheehan
,
Sinicki
,
Stubbs
and
Taylor
, cosponsored by Senators
L. Johnson
,
Larson
,
Ratcliff
and
Wirch
. Referred to Committee on Insurance.
AB1127,1,5
1
An Act
to amend
48.02 (17m) and 49.46 (2) (b) 6. c.;
to create
48.02 (17p),
2
609.73 and 632.895 (11m) of the statutes;
relating to:
coverage of speech
3
therapies as a treatment for stuttering under health insurance policies and
4
plans and the Medical Assistance program and providing speech therapy to a
5
child in need of protection or services.
Analysis by the Legislative Reference Bureau
This bill requires health insurance policies to provide coverage for habilitative and rehabilitative speech therapies in certain circumstances. Under the bill, health insurance policies that provide coverage for habilitative services must provide coverage for habilitative speech therapy as a treatment for stuttering regardless of whether the stuttering is classified as developmental; health insurance policies that provide coverage for rehabilitative services must provide coverage for rehabilitative speech therapy as a treatment for stuttering; and health insurance policies that provide coverage for both habilitative services and rehabilitative services must provide coverage for habilitative speech therapy and rehabilitative speech therapy as a treatment for stuttering. The bill provides that covered speech therapies must include coverage of speech therapy provided in person or provided via telehealth. Self-insured governmental health plans are also required to provide the coverage specified in the bill. The coverage required under the bill may not be subject to any maximum annual benefit limit, including any limits on the number of visits an insured may make to a speech-language pathologist; may not be limited based on the type of disease, injury, disorder, or other medical condition that resulted in the stuttering; and may not be subject to utilization review or utilization management requirements, including prior authorization or a determination that the speech therapy services are medically necessary. The bill provides several exceptions to this coverage requirement if the application of the coverage requirement to a qualified health plan would result in a requirement under federal law that the state pay to defray costs to qualified health plans.
The bill also expressly requires coverage of habilitative speech therapy and rehabilitative speech therapy as a treatment for stuttering by the Medical Assistance program, which is the state-administered Medicaid program that is jointly funded by the state and federal governments and that provides health services to individuals with limited financial resources.
Also, under current law, the juvenile court can order that a child is in need of protection or services (CHIPS order) and order the child’s parent or guardian or an appropriate agency to provide the child special treatment or care. The bill specifies that special treatment or care pursuant to a CHIPS order includes habilitative and rehabilitative speech therapies.
This proposal may contain a health insurance mandate requiring a social and financial impact report under s. 601.423, stats.
For further information see the state fiscal estimate, which will be printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
AB1127,1
1
Section
1
.
48.02 (17m) of the statutes is amended to read:
AB1127,3,4
2
48.02
(17m)
“Special treatment or care” means professional services
which
3
that
need to be provided to a child or his or her family to protect the well-being of
4
the child, prevent placement of the child outside the home
,
or meet the special
5
needs of the child. “Special treatment or care” also means professional services
6
which
that
need to be provided to the expectant mother of an unborn child to protect
7
the physical health of the unborn child and of the child when born from the harmful
8
effects resulting from the habitual lack of self-control of the expectant mother in the
1
use of alcohol, controlled substances
,
or controlled substance analogs, exhibited to a
2
severe degree. This term includes
, but is not limited to,
medical, psychological
,
or
3
psychiatric treatment,
speech therapy,
alcohol or other drug abuse treatment
,
or
4
other services
which
that
the court finds to be necessary and appropriate.
AB1127,2
5
Section
2
.
48.02 (17p) of the statutes is created to read:
AB1127,3,7
6
48.02
(17p)
“Speech therapy” includes all habilitative and rehabilitative
7
speech therapy services for which coverage is required under s. 632.895 (11m).
AB1127,3
8
Section
3
.
49.46 (2) (b) 6. c. of the statutes is amended to read:
AB1127,3,11
9
49.46
(2)
(b) 6. c. Speech, hearing
,
and language disorder services
, including
10
all habilitative and rehabilitative speech therapy services for which coverage is
11
required under s. 632.895 (11m)
.
AB1127,4
12
Section
4
.
609.73 of the statutes is created to read:
AB1127,3,15
13
609.73 Coverage of speech therapies.
Limited service health
14
organizations, preferred provider plans, and defined network plans are subject to s.
15
632.895 (11m).
AB1127,5
16
Section
5
.
632.895 (11m) of the statutes is created to read:
AB1127,3,17
17
632.895
(11m)
Coverage of speech therapies
. (a) In this subsection:
AB1127,3,19
18
1. “Habilitative services” means health care services that help a person keep,
19
learn, or improve skills and functioning for daily living.
AB1127,3,21
20
2. “Habilitative speech therapy” means speech therapy that helps a person
21
keep, learn, or improve skills and functioning for daily living.
AB1127,4,2
22
3. “Rehabilitative services” means health care services that help a person
1
restore or improve skills and functioning for daily living that have been lost or
2
impaired.
AB1127,4,5
3
4. “Rehabilitative speech therapy” means speech therapy that helps a person
4
restore or improve skills and functioning for daily living that have been lost or
5
impaired.
AB1127,4,11
6
5. “Telehealth” means a practice of health care delivery, diagnosis,
7
consultation, treatment, or transfer of medically relevant data by means of audio,
8
video, or data communications that are used either during a patient visit or a
9
consultation or are used to transfer medically relevant data about a patient.
10
“Telehealth” does not include communications delivered solely by audio-only
11
telephone, facsimile machine, or email.
AB1127,4,16
12
(b) 1. Except as provided in par. (d), every disability insurance policy, and
13
every self-insured health plan of the state or a county, city, town, village, or school
14
district, that provides coverage for habilitative services shall provide coverage for
15
habilitative speech therapy as a treatment for stuttering regardless of whether the
16
stuttering is classified as developmental.
AB1127,4,20
17
2. Except as provided in par. (d), every disability insurance policy, and every
18
self-insured health plan of the state or a county, city, town, village, or school
19
district, that provides coverage for rehabilitative services shall provide coverage for
20
rehabilitative speech therapy as a treatment for stuttering.
AB1127,5,4
21
3. Except as provided in par. (d), every disability insurance policy, and every
22
self-insured health plan of the state or a county, city, town, village, or school
23
district, that provides coverage for both habilitative services and rehabilitative
1
services shall provide coverage for habilitative speech therapy as a treatment for
2
stuttering regardless of whether the stuttering is classified as developmental and
3
shall provide coverage for rehabilitative speech therapy as a treatment for
4
stuttering.
AB1127,5,7
5
(c) 1. a. The coverage required under par. (b) may not be subject to any
6
maximum annual benefit limit, including any limit on the number of visits an
7
insured may make to a speech-language pathologist.
AB1127,5,10
8
b. The coverage required under par. (b) may not be limited on the basis of the
9
type of disease, injury, disorder, or other medical condition that resulted in the
10
stuttering.
AB1127,5,13
11
c. The coverage required under par. (b) may not be subject to utilization review
12
or utilization management requirements, including prior authorization or a
13
determination that the speech therapy services are medically necessary.
AB1127,5,15
14
2. The coverage required under par. (b) shall include coverage of speech
15
therapy provided in person or provided via telehealth.
AB1127,5,21
16
(d) If the application of any requirement under this subsection to a qualified
17
health plan, as defined in
42 USC 18021
(a) (1), would result in a determination
18
that the state must make payments to defray costs under
42 USC 18031
(d) (3) and
19
45 CFR 155.170
, then the coverage requirements under this subsection do not apply
20
to the qualified health plan until the application of the requirements under this
21
subsection to the qualified health plan do not require the state to defray any costs.
AB1127,6
22
Section
6
. Nonstatutory provisions.
AB1127,6,5
23
(
1
)
Legislative intent.
It is the legislature’s intent that, for purposes of
45
1
CFR 156.11
5, the speech therapy benefits required under this act be considered
2
substantially equal to the benefits required under the state’s EHB-benchmark plan,
3
as defined in
45 CFR 156.2
0, and that, for purposes of
45 CFR 155.17
0, the speech
4
therapy benefits required under this act be considered a benefit required by state
5
action for purposes of compliance with federal requirements.
AB1127,6,6
6
(
2
)
Qualified health plans.
AB1127,6,11
7
(
a
) Within 90 days following the effective date of this paragraph, the office of
8
the commissioner of insurance shall determine whether the application of any
9
speech therapy benefits required under this act to a qualified health plan, as
10
defined in
42 USC 18021
(a) (1), is in addition to the essential health benefits
11
required under federal law.
AB1127,6,21
12
(
b
) If the office of the commissioner of insurance determines under par. (
a
)
13
that the application of any speech therapy benefits required under this act is in
14
addition to the essential health benefits required under federal law, then the office
15
of the commissioner of insurance shall, within 180 days following the effective date
16
of this paragraph, apply for a waiver under
42 USC 18052
or any other applicable
17
federal law of any of the applicable cost defrayal requirements under
42 USC 18031
18
(d) (3) and
45 CFR 155.170
. In seeking a waiver of federal law under this
19
paragraph, the office of the commissioner of insurance may propose changes to the
20
state’s EHB-benchmark plan, as defined in
45 CFR 156.20
, that are not in conflict
21
with state law.
AB1127,7
22
Section
7
. Initial applicability.
AB1127,7,2
23
(
1
) For policies and plans containing provisions inconsistent with this act, this
1
act first applies to policy or plan years beginning on the effective date of this
2
subsection, except as provided in sub. (
2
).
AB1127,7,7
3
(
2
) For policies and plans that are affected by a collective bargaining
4
agreement containing provisions inconsistent with this act, this act first applies to
5
policy or plan years beginning on the effective date of this subsection or on the day
6
on which the collective bargaining agreement is newly established, extended,
7
modified, or renewed, whichever is later.
AB1127,8
8
Section
8
. Effective date.
AB1127,7,10
9
(
1
) This act takes effect on the first day of the 4th month beginning after
10
publication.
AB1127,7,11
11
(end)
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