Wisconsin Senate Bill SB1136

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

SB1136 would change Wisconsin insurance law to limit how insurers and certain self-insured health plans evaluate prior authorization requests for treatment of severe tooth misalignment or malocclusion. 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 treatment. It also extends this requirement to several categories of public and quasi-public health coverage, including state employee plans, local government self-insured plans, school district plans, and voluntary nonprofit health care plans organized as cooperative associations. The bill creates new statutory sections, 609.823 and 632.851, to establish the prior-authorization rule and ties limited service health organizations, preferred provider plans, and defined network plans to the same standard. It also amends multiple existing statutes to incorporate the new requirement into the state’s insurance and public employee benefit framework. The bill would take effect four months after publication, with delayed applicability for plans governed by collective bargaining agreements until those agreements are newly established, extended, modified, or renewed.

Impact

If enacted, SB1136 would alter Wisconsin insurance and employee-benefit statutes by prohibiting sole reliance on the Salzmann Evaluation Index for prior authorization of orthodontic treatment for severe misalignment or malocclusion. The change would affect private disability insurance policies, self-insured health plans, state and local government health plans, school district self-insured plans, and certain nonprofit cooperative health plans, requiring them to use additional clinical or administrative criteria beyond that index when reviewing coverage requests.

Sentiment

The available record shows little formal debate or recorded voting activity, so there is no detailed committee sentiment to summarize. Based on the bill’s subject matter and sponsorship, the measure appears to be a targeted consumer-coverage reform aimed at improving access to orthodontic treatment, and there is no evidence in the provided materials of organized opposition or amendment controversy. The bill ultimately failed to pass pursuant to Senate Joint Resolution 1.

Contention

The main point of contention is likely the bill’s restriction on insurers’ use of the Salzmann Evaluation Index as a sole decision tool, since that changes prior-authorization standards and could increase approvals for treatment that insurers might otherwise deny. Insurers and plan administrators may view the mandate as limiting utilization review and increasing costs, while supporters would likely argue that the index should not be the only basis for determining medical necessity for severe malocclusion treatment. The bill also includes special effective-date rules for collectively bargained plans, which can create implementation complexity for public employers and unions.