Assembly Bill 338 mandates that health insurance policies and self-insured governmental health plans in Wisconsin provide coverage for at least 28 appointments or visits with a mental health care provider each policy year for the treatment of mental health or substance use disorders. Alternatively, plans must cover as many appointments as necessary to meet the insured's treatment goals. The bill also prohibits these plans from requiring prior authorization for such appointments. Additionally, the Office of the Commissioner of Insurance is tasked with preparing a preliminary actuarial estimate of the average cost for all qualified health plans related to this coverage. If this estimate indicates an increase of more than 10 percent, the coverage requirements will not be enforced.

The bill introduces new sections to the statutes, specifically creating 609.865 and 632.895 (12g), which outline the coverage requirements and the role of the Office of the Commissioner of Insurance in assessing the financial impact of these mandates. The provisions will apply to policy or plan years beginning on the effective date of the bill, with specific considerations for policies affected by collective bargaining agreements. The act is set to take effect four months after publication.