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Bill > SB342

WI SB342

WI SB342
Coverage of treatment for mental health or substance use disorders under health insurance policies and plans.

summary

Introduced
06/27/2025
In Committee
06/27/2025
Crossed Over
Passed
Dead

Introduced Session

2025-2026 Regular Session

Bill Summary

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. LRB-3579/1 JPC:amn 2025 - 2026 Legislature SENATE BILL 342 This proposal may contain a health insurance mandate requiring a social and financial impact report under s. 601.423, stats.

AI Summary

This bill requires health insurance policies and self-insured governmental health plans that provide mental health or behavioral health coverage to offer at least 28 annual appointments with a mental health care provider, or as many visits as needed to meet the patient's treatment goals. The bill prohibits these insurance plans from requiring prior authorization for mental health treatment visits. A key provision is that the Office of the Commissioner of Insurance (OCI) must conduct a preliminary actuarial estimate to determine the cost impact of this coverage requirement on qualified health plans. If the estimated cost increase exceeds 10 percent, the OCI will not be required to enforce the coverage mandate. The bill applies to various types of health insurance plans, including disability insurance policies, limited service health organizations, preferred provider plans, and defined network plans. The new requirements will take effect for policy or plan years beginning after the bill's publication, with special considerations for existing collective bargaining agreements. This legislation aims to improve access to mental health and substance use disorder treatment by removing potential barriers like prior authorization and ensuring a minimum number of covered provider visits.

Committee Categories

Agriculture and Natural Resources

Sponsors (40)

Tim Carpenter (D)*,  Dora Drake (D)*,  Dianne Hesselbein (D)*,  LaTonya Johnson (D)*,  Chris Larson (D)*,  Brad Pfaff (D)*,  Melissa Ratcliff (D)*,  Kelda Roys (D)*,  Jeff Smith (D)*,  Bob Wirch (D)*,  Clint Anderson (D),  Margaret Arney (D),  Mike Bare (D),  Brienne Brown (D),  Ryan Clancy (D),  Karen DeSanto (D),  Ben DeSmidt (D),  Jodene Emerson (D),  Joan Fitzgerald (D),  Russell Goodwin (D),  Kalan Haywood (D),  Francesca Hong (D),  Alex Joers (D),  Tara Johnson (D),  Darrin Madison (D),  Vincent Miresse (D),  Supreme Moore Omokunde (D),  Greta Neubauer (D),  Lori Palmeri (D),  Christian Phelps (D),  Pricilla Prado (D),  Amaad Rivera-Wagner (D),  Ann Roe (D),  Joe Sheehan (D),  Christine Sinicki (D),  Angela Stroud (D),  Shelia Stubbs (D),  Angelito Tenorio (D),  Randy Udell (D),  Robyn Vining (D), 

Last Action

Commissioner of Insurance report received pursuant to s.601.423(2), Wisconsin Statutes (on 07/14/2025)
(1 Companion Bills)

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