Wisconsin 2023-2024 Regular Session

Wisconsin Assembly Bill AB1149 Compare Versions

Only one version of the bill is available at this time.

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1	1	LRB-4089/1
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3	3	2023 - 2024 LEGISLATURE
4	4	2023 ASSEMBLY BILL 1149
5	5	March 6, 2024 - Introduced by Representatives VINING, MOORE OMOKUNDE,
6	6	CONSIDINE, PALMERI, BARE, EMERSON, JOERS, MADISON, OHNSTAD, ORTIZ-VELEZ,
7	7	RATCLIFF, SHANKLAND and STUBBS, cosponsored by Senator AGARD. Referred to
8	8	Committee on Insurance.
9	9	*AUTHORS SUBJECT TO CHANGE*
10	10	AN ACT to create 609.865 and 632.895 (12g) of the statutes; relating to:
11	11	coverage of treatment for mental health or substance use disorders under
12	12	health insurance policies and plans.
13	13	Analysis by the Legislative Reference Bureau
14	14	This bill requires health insurance policies and self-insured governmental
15	15	health plans that provide coverage of mental health or behavioral health items or
16	16	services to cover in each policy year at least 28 appointments or visits with a mental
17	17	health care provider to treat mental health or substance use disorders or as many
18	18	appointments or visits with a mental health care provider as are necessary to meet
19	19	the insured's treatment goals. The bill prohibits health insurance policies and
20	20	self-insured governmental health plans from requiring prior authorization for the
21	21	coverage of appointments or visits under the bill. Health insurance policies are
22	22	known as disability insurance policies in the bill. Further, this bill requires the
23	23	Office of the Commissioner of Insurance to prepare a preliminary actuarial estimate
24	24	of the average cost for all qualified health plans, as defined under federal law,
25	25	attributable to the coverage required under the bill. If the preliminary actuarial
26	26	estimate of the average cost for all qualified health plans is an increase of greater
27	27	than 10 percent, OCI may not enforce the coverage requirements under the bill.
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32	32	ASSEMBLY BILL 1149
33	33	This proposal may contain a health insurance mandate requiring a social and
34	34	financial impact report under s. 601.423, stats.
35	35	The people of the state of Wisconsin, represented in senate and assembly, do
36	36	enact as follows:
37	37	SECTION 1. 609.865 of the statutes is created to read:
38	38	609.865 Coverage of treatment for mental health or substance use
39	39	disorders. Limited service health organizations, preferred provider plans, and
40	40	defined network plans are subject to s. 632.895 (12g).
41	41	SECTION 2. 632.895 (12g) of the statutes is created to read:
42	42	632.895 (12g) TREATMENT OF MENTAL HEALTH OR SUBSTANCE USE DISORDERS. (a)
43	43	Subject to par. (c), every disability insurance policy and self-insured health plan of
44	44	the state or a county, city, village, town, or school district that provides coverage of
45	45	mental health or behavioral health items or services shall provide in each policy year
46	46	coverage of at least 28 appointments or visits with a mental health care provider to
47	47	treat mental health or substance use disorders or as many appointments or visits
48	48	with a mental health care provider as are necessary to meet the insured's treatment
49	49	goals.
50	50	(b) No disability insurance policy or self-insured health plan that is required
51	51	to provide the coverage under par. (a) may require prior authorization for the
52	52	coverage under par. (a).
53	53	(c) 1. The office of the commissioner of insurance shall prepare a preliminary
54	54	actuarial estimate of the average cost for all qualified health plans, as defined in 45
55	55	CFR 155.20, attributable to the coverage required under par. (a). The office of the
56	56	commissioner of insurance shall prepare the preliminary actuarial estimate based
57	57	on an analysis performed in accordance with generally accepted actuarial principles
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79	79	LRB-4089/1
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81	81	SECTION 2
82	82	ASSEMBLY BILL 1149
83	83	and methodologies. The office of the commissioner of insurance may, in consultation
84	84	with the federal centers for medicare and medicaid services, select factors and
85	85	methodology as necessary to prepare the preliminary actuarial estimate under this
86	86	subdivision.
87	87	2. If the preliminary actuarial estimate of the average cost for all qualified
88	88	health plans described under subd. 1. is an increase of greater than 10 percent, the
89	89	office of the commissioner of insurance may not enforce par. (a).
90	90	SECTION 3.0Initial applicability.
91	91	(1) For policies and plans containing provisions inconsistent with s. 632.895
92	92	(12g), the treatment of s. 632.895 (12g) first applies to policy or plan years beginning
93	93	on the effective date of this subsection, except as provided in sub. (2).
94	94	(2) For policies and plans that are affected by a collective bargaining agreement
95	95	containing provisions inconsistent with s. 632.895 (12g), the treatment of s. 632.895
96	96	(12g) first applies to policy or plan years beginning on the effective date of this
97	97	subsection or on the day on which the collective bargaining agreement is newly
98	98	established, extended, modified, or renewed, whichever is later.
99	99	SECTION 4.0Effective date.
100	100	(1) This act takes effect on the first day of the 4th month beginning after
101	101	publication.
102	102	(END)
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