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Wisconsin Legislature: AB338: Bill Text
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AB338: Bill Text
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2025 - 2026 LEGISLATURE
LRB-1677/1
JPC:amn
2025 ASSEMBLY BILL 338
July 8, 2025 - Introduced by Representatives
Vining
,
Roe
,
DeSanto
,
Moore Omokunde
,
Palmeri
,
Anderson
,
Arney
,
Bare
,
Brown
,
Clancy
,
DeSmidt
,
Emerson
,
Fitzgerald
,
Goodwin
,
Haywood
,
Hong
,
Joers
,
Johnson
,
Madison
,
Miresse
,
Neubauer
,
Phelps
,
Prado
,
Rivera-Wagner
,
Sheehan
,
Sinicki
,
Stroud
,
Stubbs
,
Tenorio
and
Udell
, cosponsored by Senators
Roys
,
L. Johnson
,
Carpenter
,
Drake
,
Hesselbein
,
Larson
,
Pfaff
,
Ratcliff
,
Smith
and
Wirch
. Referred to Committee on Insurance.
AB338,1,3
1
An Act
to create
609.865 and 632.895 (12g) of the statutes;
relating to:
2
coverage of treatment for mental health or substance use disorders under
3
health insurance policies and plans.
Analysis by the Legislative Reference Bureau
This bill requires health insurance policies and self-insured governmental health plans that provide coverage of mental health or behavioral health items or services to cover in each policy year at least 28 appointments or visits with a mental health care provider to treat mental health or substance use disorders or as many appointments or visits with a mental health care provider as are necessary to meet the insured’s treatment goals. The bill prohibits health insurance policies and self-insured governmental health plans from requiring prior authorization for the coverage of appointments or visits under the bill. Health insurance policies are known as disability insurance policies in the bill. Further, this bill requires the Office of the Commissioner of Insurance to prepare a preliminary actuarial estimate of the average cost for all qualified health plans, as defined under federal law, attributable to the coverage required under the bill. If the preliminary actuarial estimate of the average cost for all qualified health plans is an increase of greater than 10 percent, OCI may not enforce the coverage requirements under the bill.
This proposal may contain a health insurance mandate requiring a social and financial impact report under s. 601.423, stats.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
AB338,1
1
Section
1
.
609.865 of the statutes is created to read:
AB338,2,4
2
609.865 Coverage of treatment for mental health or substance use
3
disorders.
Limited service health organizations, preferred provider plans, and
4
defined network plans are subject to s. 632.895 (12g).
AB338,2
5
Section
2
.
632.895 (12g) of the statutes is created to read:
AB338,2,13
6
632.895
(12g)
Treatment of mental health or substance use disorders
.
7
(a) Subject to par. (c), every disability insurance policy and self-insured health plan
8
of the state or a county, city, village, town, or school district that provides coverage
9
of mental health or behavioral health items or services shall provide in each policy
10
year coverage of at least 28 appointments or visits with a mental health care
11
provider to treat mental health or substance use disorders or as many
12
appointments or visits with a mental health care provider as are necessary to meet
13
the insured’s treatment goals.
AB338,2,16
14
(b) No disability insurance policy or self-insured health plan that is required
15
to provide the coverage under par. (a) may require prior authorization for the
16
coverage under par. (a).
AB338,3,5
17
(c) 1. The office of the commissioner of insurance shall prepare a preliminary
18
actuarial estimate of the average cost for all qualified health plans, as defined in
45
19
CFR 155.20
, attributable to the coverage required under par. (a). The office of the
20
commissioner of insurance shall prepare the preliminary actuarial estimate based
1
on an analysis performed in accordance with generally accepted actuarial
2
principles and methodologies. The office of the commissioner of insurance may, in
3
consultation with the federal centers for medicare and medicaid services, select
4
factors and methodology as necessary to prepare the preliminary actuarial
5
estimate under this subdivision.
AB338,3,8
6
2. If the preliminary actuarial estimate of the average cost for all qualified
7
health plans described under subd. 1. is an increase of greater than 10 percent, the
8
office of the commissioner of insurance may not enforce par. (a).
AB338,3
9
Section
3
. Initial applicability.
AB338,3,12
10
(
1
) For policies and plans containing provisions inconsistent with s. 632.895
11
(12g), the treatment of s. 632.895 (12g) first applies to policy or plan years
12
beginning on the effective date of this subsection, except as provided in sub. (
2
).
AB338,3,17
13
(
2
) For policies and plans that are affected by a collective bargaining
14
agreement containing provisions inconsistent with s. 632.895 (12g), the treatment
15
of s. 632.895 (12g) first applies to policy or plan years beginning on the effective date
16
of this subsection or on the day on which the collective bargaining agreement is
17
newly established, extended, modified, or renewed, whichever is later.
AB338,4
18
Section
4
. Effective date.
AB338,3,20
19
(
1
) This act takes effect on the first day of the 4th month beginning after
20
publication.
AB338,3,21
21
(end)
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