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LRB-2837/1
TJD:kjf
2015 - 2016 LEGISLATURE
January 13, 2016 - Introduced by Representatives VanderMeer, Tittl, Ballweg,
Horlacher, Knodl, Kremer, Murphy, A. Ott, Quinn, Rohrkaste, Sanfelippo,
Zepnick, Novak and Kitchens, cosponsored by Senator Harsdorf. Referred to
Committee on Health.
AB713,1,3 1An Act to create 49.45 (29w) (a) 3. to 7., 49.45 (29w) (c) and 49.45 (29w) (d) of
2the statutes; relating to: access to and prior authorization for mental health
3services under the Medical Assistance program.
Analysis by the Legislative Reference Bureau
This bill sets limitations on what is required for prior authorizations for mental
health treatment under the Medical Assistance (MA) program. Specifically, the bill
limits the information that may be collected on a prior authorization form, requires
the Department of Health Services (DHS) to allow 24 mental health therapy visits
before requiring prior authorization for additional visits, requires DHS to allow 15
days of adolescent day treatment services before requiring prior authorization for
additional days, and creates a preferred provider status for purposes of processing
prior authorization requests. The bill also requires a health maintenance
organization that provides mental health services under the MA program to use
uniform application, provider recertification, and prior authorization forms and
processes prescribed by DHS and to allow mental health agencies to replace a
departing mental health professional on the provider panel with another mental
health professional of similar qualifications who agrees to abide by the health
maintenance organization's policies.

For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB713,1 1Section 1. 49.45 (29w) (a) 3. to 7. of the statutes are created to read:
AB713,2,32 49.45 (29w) (a) 3. Allow 24 mental health therapy visits before requiring prior
3authorization for additional mental health visits.
AB713,2,54 4. Allow 15 days of adolescent day treatment services before requiring prior
5authorization for additional days of adolescent day treatment services.
AB713,2,76 5. Limit the collection of information on the prior authorization form for mental
7health services to the following elements:
AB713,2,88 a. Diagnostic criteria and symptoms.
AB713,2,99 b. Patient and mental health services provider identification.
AB713,2,1110 c. Modality and frequency of treatment for which prior authorization is
11requested.
AB713,2,1312 d. Goals and discharge criteria for treatment for which prior authorization is
13requested.
AB713,2,1714 6. Limit the collection of information on prior authorization forms and by
15reviewers for prior authorization of mental health services to the information that
16is within the scope of practice of the mental health service provider requesting prior
17authorization to provide treatment.
AB713,2,2018 7. Limit the collection of information for prior authorization renewals to
19measures of progress on treatment goals and to new information on the individual's
20condition for which prior authorization for treatment is being requested.
AB713,2 21Section 2. 49.45 (29w) (c) of the statutes is created to read:
AB713,3,4
149.45 (29w) (c) 1. For purposes of reviewing requests for prior authorization
2for mental health services provided under this subchapter, the department shall
3recognize a preferred provider status which is a mental health service provider that
4meets all of the following criteria:
AB713,3,65 a. The mental health service provider has a minimum of 5 years of experience
6as a certified provider under the Medical Assistance program under this subchapter.
AB713,3,87 b. The mental health service provider has had no instances of substantiated
8fraud in the 5 years previous to requesting preferred provider status.
AB713,3,129 c. The mental health service provider has a history of having 90 percent of prior
10authorization requests approved, regardless of whether the department requested
11additional information before approval, for the 3 years previous to requesting
12preferred provider status.
AB713,3,1613 2. In providing mental health benefits under this subchapter, the department
14shall process prior authorization requests from a mental health service provider with
15preferred provider status under subd. 1. automatically, without delay, in a manner
16similar to claims for services that do not require prior authorization.
AB713,3,1817 3. A mental health service provider may appeal denial of or termination of
18preferred provider status under subd. 1. under ch. 227.
AB713,3 19Section 3. 49.45 (29w) (d) of the statutes is created to read:
AB713,3,2120 49.45 (29w) (d) A health maintenance organization that provides mental
21health services under this subchapter shall do all of the following:
AB713,3,2422 1. Use uniform application, provider recertification, and prior authorization
23forms and processes prescribed by the department for use by all health maintenance
24organizations providing mental health services under this subchapter.
AB713,4,5
12. Allow a mental health agency that is certified to provide mental health
2service under the Medical Assistance program under this subchapter to replace a
3departing mental health professional on the health maintenance organization's
4provider panel with another mental health professional of similar qualifications who
5agrees to abide by the policies of the health maintenance organization.
AB713,4,66 (End)
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