Wisconsin Assembly Bill AB1214

Wisconsin 2025-2026 Regular Session

• Introduced: 3/19/26
• Refer: 3/19/26
• Failed: 3/23/26

Caption

An Act to amend 40.51 (8), 40.51 (8m), 66.0137 (4), 120.13 (2) (g) and 185.983 (1) (intro.); to create 609.823 and 632.851 of the statutes; Relating to: prior authorization for treatment of severe misalignment or malocclusion of teeth under health insurance policies and plans.

Summary

AB1214 would restrict how certain health insurance policies and self-insured health plans make prior authorization decisions for coverage of treatment for severe misalignment or malocclusion of teeth. The bill specifically bars disability insurance policies and self-insured health plans that cover dental and related services from relying solely on the Salzmann Evaluation Index when deciding whether to approve such treatment. It also applies this rule to limited service health organizations, preferred provider plans, and defined network plans through a new cross-reference to the new prior-authorization standard. To implement that policy, the bill amends several statutes governing state employee health coverage, local government self-insured plans, school district self-insured plans, and voluntary nonprofit health care plans. It adds a new statutory section, 632.851, establishing the prohibition on sole reliance on the Salzmann Evaluation Index, and a related section, 609.823, making certain plan types subject to that rule. The bill includes delayed applicability language for existing policies and plans, including special timing for collective bargaining agreements, and would take effect four months after publication.

Impact

The bill would change Wisconsin insurance and public-employee health plan law by limiting a specific prior-authorization practice for orthodontic or dental treatment. It would affect disability insurance policies, self-insured health plans, state and local government plans, school district plans, and certain nonprofit cooperative health plans that cover dental and related services. The practical effect is to require insurers and plans to consider more than the Salzmann Evaluation Index alone when reviewing coverage for treatment of severe tooth misalignment or malocclusion.

Sentiment

The available record shows no committee transcript or recorded votes, so there is no detailed public debate captured here. Based on the bill’s subject matter and its targeted consumer-protection approach, the measure appears to be framed as a patient-access and fairness bill rather than a broad insurance overhaul. The bill ultimately failed to pass pursuant to Senate Joint Resolution 1, indicating it did not advance to enactment despite introduction.

Contention

The main point of contention is likely the bill’s restriction on insurer and plan discretion in prior authorization, especially for orthodontic coverage decisions. Supporters would likely favor the bill because it prevents a single clinical scoring tool from being the sole basis for denial, while insurers and self-insured plans may view it as limiting utilization management and increasing coverage costs or administrative complexity. Another possible area of concern is how the new rule interacts with collective bargaining agreements and existing plan designs, since the bill delays applicability for plans governed by inconsistent labor contracts.