Wisconsin Assembly Bill AB368

Wisconsin 2025-2026 Regular Session

• Introduced: 7/17/25
• Refer: 7/17/25
• Report Pass: 12/17/25
• Refer: 12/17/25
• Failed: 3/23/26

Caption

An Act to amend 632.85 (title) and 632.85 (3); to create 632.85 (1) (d) and 632.851 of the statutes; Relating to: prior authorization for coverage of physical therapy, occupational therapy, speech therapy, chiropractic services, and other services under health plans.

Summary

AB368 would change Wisconsin insurance law to limit prior authorization requirements for certain rehabilitative and pain-management services. For physical therapy, occupational therapy, speech therapy, and chiropractic care, the bill bars prior authorization for the first 12 visits of an episode of care, and it also bars prior authorization for the first 90 days of nonpharmacologic treatment for chronic pain, subject to a twice-per-week limit per service. After those initial visits, plans could require reauthorization, but they would have to decide within three business days or the request would be deemed approved. The bill also requires health plans to give providers and patients clearer explanations when services are denied or reduced, and to align copays and coinsurance for these services with primary care cost-sharing when cost-sharing applies. In addition, it imposes new transparency and staffing rules on utilization review and utilization management organizations, including providing evidence-based policy information tied to coverage algorithms, prohibiting the use of claims data as outcome evidence for algorithm development, and requiring peer review by Wisconsin-licensed providers with appropriate credentials. It further expands the existing prior-authorization ban to cover medically necessary services incidental to surgery and urgent health care services.

Impact

AB368 would amend s. 632.85 and create new s. 632.851 of the Wisconsin statutes, expanding limits on prior authorization for private health benefit plans and self-insured governmental health plans. It would directly affect insurers, utilization review organizations, utilization management organizations, health care providers, and covered individuals by reducing administrative hurdles for therapy, chiropractic, urgent care, and certain post-surgical services, while also imposing new notice, turnaround, and staffing requirements. The bill may also trigger a social and financial impact report because it could be treated as a health insurance mandate.

Sentiment

The available record shows no committee transcript or recorded votes, so there is no documented floor or committee debate to gauge detailed sentiment. Based on the bill’s sponsorship and structure, the measure appears to be framed as a patient-access and provider-administrative-burden reduction bill, with an emphasis on faster approvals and less insurer gatekeeping for therapy and pain treatment. Its final status indicates it ultimately failed to pass pursuant to Senate Joint Resolution 1.

Contention

The main likely points of contention are the bill’s restrictions on insurer prior authorization authority and the operational limits it places on utilization management. Insurers and managed-care organizations may object to the automatic approval provision after three business days, the ban on using claims data as outcome evidence for algorithms, and the requirement that peer review be staffed by Wisconsin-licensed providers with relevant credentials. Supporters would likely emphasize improved access to care, reduced delays for therapy and chronic pain treatment, and greater transparency in coverage decisions.