MedicaidPrior AuthHigh impact
ForwardHealth Update 2025-38: Prior Authorization Process Improvements: Removing Spell of Illness and Revising Limits for Therapy ServicesFebruary 9, 2026: This Update has been revised since its original publication. Audiologists will now receive the ForwardHealth Update, two ForwardHealth Online Handbook topics were added to the Quick Links section, and information about Individualized Education Plan (IEP) submissions was added. Revised information appears in red text on pages 1 and 2.
Wisconsin ForwardHealth·WI · Physical Therapy, Occupational Therapy·Prior Authorization
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
Effective January 1, 2026, ForwardHealth is discontinuing the spell of illness policy for PT, OT, and SLP services and changing from a lifetime limit to an annual limit of 35 visits per discipline before prior authorization is required. Providers must use new process types and updated forms for all prior authorization requests.
Action Required
By January 1, 2026: Stop using SOI process types 114, 115, and 116 - these will be returned. Use process types 111, 112, and 113 instead. Update to revised Prior Authorization/Therapy Attachment form F-11008 (12/2025) - outdated forms will be returned. Stop submitting Individualized Education Plans for school-aged children. Discontinue use of PA/SOIA form F-11039 as it becomes obsolete. Train billing staff on new annual 35-visit limit per discipline instead of lifetime limit.