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.
Summary
SB342 would require most disability insurance policies and certain self-insured governmental health plans in Wisconsin that already 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 those plans from requiring prior authorization for the covered visits.
The bill applies to limited service health organizations, preferred provider plans, and defined network plans through a new cross-reference to the same coverage mandate. It also directs the Office of the Commissioner of Insurance (OCI) to prepare a preliminary actuarial estimate of the average cost of the mandate for qualified health plans. If OCI determines the average cost increase would exceed 10 percent, OCI may not enforce the new coverage requirement for those plans.
Impact
SB342 would amend Wisconsin insurance law by creating new sections 609.865 and 632.895 (12g), adding a statewide mental health and substance use disorder treatment coverage mandate for disability insurance policies and certain public self-insured health plans. It would affect insurers, state and local government health plans, and school district plans, while also extending the requirement to several managed care plan types through the new statutory cross-reference. The bill would also limit utilization management by prohibiting prior authorization for the mandated visits and would condition enforcement on an OCI actuarial review for qualified health plans if the estimated premium impact exceeds 10 percent.
Sentiment
The bill appears to have been introduced with strong support from a broad group of Senate and Assembly Democrats and allied cosponsors, suggesting favorable sentiment toward expanding behavioral health coverage. No committee transcript or recorded vote information is provided, but the bill’s subject matter and sponsorship pattern indicate a generally pro-mental-health, pro-coverage posture. Its eventual failure to pass pursuant to Senate Joint Resolution 1 indicates that, despite support from sponsors, it did not advance to enactment.
Contention
The main points of contention are likely the cost and insurance-mandate implications of requiring at least 28 covered visits and eliminating prior authorization. The OCI actuarial trigger reflects concern that the mandate could raise premiums, especially for qualified health plans, and the bill explicitly allows non-enforcement if the average cost increase would exceed 10 percent. Another likely area of debate is the scope of the mandate, including its application to self-insured governmental plans and plans subject to collective bargaining agreements, which could affect employers, public entities, insurers, and labor groups.
Crossfiled
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.