An Act to create 609.865 and 632.895 (12g) of the statutes; Relating to: coverage of treatment for mental health or substance use disorders under health insurance policies and plans.
AB338 would require certain Wisconsin health insurance policies and self-insured governmental health plans that cover mental health or behavioral health services to provide at least 28 appointments or visits per policy year with a mental health care provider for treatment of mental health or substance use disorders, or more visits if needed to meet the insured’s treatment goals. The bill also bars prior authorization for those covered visits, making access to ongoing outpatient mental health and substance use treatment easier for covered members.
The bill applies to disability insurance policies, limited service health organizations, preferred provider plans, defined network plans, and self-insured plans of the state and local governments, including counties, cities, villages, towns, and school districts. It would create new statutory provisions in ss. 609.865 and 632.895(12g), and it includes an applicability clause for collective bargaining agreements so that affected plans tied to labor contracts would comply when those agreements are renewed or modified.
AB338 also includes a cost-control trigger. The Office of the Commissioner of Insurance must prepare a preliminary actuarial estimate of the average cost impact on qualified health plans, and if that estimate shows an increase of more than 10 percent, OCI may not enforce the new coverage mandate. This makes the bill a health insurance mandate with a built-in fiscal safeguard intended to limit premium impacts.
Overall, the bill appears to have been framed as a mental health access measure, with the policy goal of expanding treatment continuity and reducing administrative barriers such as prior authorization. The available record shows no committee transcript or recorded votes, so there is no documented floor debate in the provided materials. Its final status indicates it failed to pass pursuant to Senate Joint Resolution 1.
Because the bill concerns insurance coverage for behavioral health and substance use treatment, likely points of interest include affordability, premium effects, insurer administrative burden, and the scope of mandated benefits. The main tension is between expanding access to mental health care and limiting cost increases for insurers, employers, and public plans.
AB338 would amend Wisconsin insurance law by creating new coverage requirements for mental health and substance use disorder treatment in disability insurance policies and certain self-insured governmental health plans. It would require at least 28 covered outpatient visits per year, prohibit prior authorization for those visits, and direct OCI to conduct an actuarial review that could block enforcement if the estimated cost increase for qualified health plans exceeds 10 percent. The bill would therefore expand mandated benefits while also affecting plan administration, premium-setting, and collective bargaining-related plan design.
The bill’s apparent sentiment is generally supportive of expanded mental health and substance use disorder coverage, with the broad bipartisan-style sponsorship list suggesting interest in access to care. At the same time, the inclusion of an actuarial cost threshold indicates awareness of potential premium and fiscal concerns. No committee testimony or vote record was provided, so the available materials do not show direct opposition or support statements beyond the bill’s structure and sponsorship.
The main point of contention is likely the balance between access and cost. Supporters would favor guaranteed outpatient mental health and substance use treatment visits and the elimination of prior authorization, while opponents or cost-conscious stakeholders may object to the mandate’s potential effect on premiums, plan costs, and administrative flexibility. The 10 percent actuarial trigger suggests insurers, employers, and public-plan administrators were expected to scrutinize the financial impact, and the collective bargaining applicability language could also matter to public-sector labor stakeholders.