WI AB368

Health plans prohibited from requiring prior authorization for the first 12 physical therapy, occupational therapy, speech therapy, or chiropractic visits per episode of care, with no duration limitation

Prior authorization prohibited for chronic pain patients receiving physical therapy, occupational therapy, or chiropractic care for nonpharmacologic pain management during the first 90 days of treatment, limited to twice weekly per service

Reauthorization decisions must be issued within 3 business days after the initial 12 visits; failure to respond within this timeframe results in automatic approval

Health plans prohibited from requiring prior authorization for services incidental to covered surgeries deemed medically necessary or for urgent health care services that could jeopardize life, health, or subject patients to severe unmanageable pain

Utilization review organizations must provide medical evidence-based policy information to providers upon request, staff peer reviews with Wisconsin-licensed providers credentialed in the relevant service type, and cannot use claims data alone to develop coverage algorithms