WI SB373

Health plans cannot require 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 is prohibited for chronic pain patients (pain lasting 3+ months) receiving physical therapy, occupational therapy, or chiropractic care for the first 90 days of treatment, up to twice weekly per service

Health plans must issue reauthorization decisions within 3 business days after the initial 12 visits; failure to respond results in automatic approval

Prior authorization is prohibited for covered services incidental to surgery deemed medically necessary and for urgent health care services that could jeopardize life, health, or subject patients to severe unmanageable pain

Copayments and coinsurance for these therapy services must equal primary care rates, and utilization review organizations must staff peer reviews with Wisconsin-licensed providers credentialed in the service type being reviewed