The CSW met with the WI Department of Health Services in Representative Dr. Clint Moses’s office this week to discuss the proposed 2026 changes to the current Medicaid chiropractic program.
The proposed changes are as follows:
- Initiate new payments for extra spinal adjustments performed by Chiropractors
- Remove the current 30 day “pause” in chiropractic care.
- Initiate a pre-authorization for chiropractic services after completion of 20 visits in a calendar year.
- There is no cap on number of chiropractic visits in a calendar year, the DC is only required to obtain pre-authorization for any visits exceeding 20.
The CSW and DHS are also discussing providing joint educational programs once the final terms are agreed upon. DHS has assured the CSW that they will have sufficient pre-authorization reviewers to prevent any delay in patient care. There were a few questions that DHS has to review yet and will get back to the CSW. The questions are primarily related to how the visits are tracked and whether tracking will be by patient or DC to prevent “doctor hopping”. If any chiropractor has questions, please send them to insurance@cswchiro.org
Summary:
- The proposed changes actually increase access to chiropractic care by eliminating the current arbitrary 30 days where a patient cannot be seen by a chiropractor.
- The national average for a chiropractic treatment plan is 12-18 visits, so the majority of patients should not require pre-authorization beyond 20 visits.
- For those patients who do need more than 20 visits in a calendar year, the pre-authorization process appears to be streamlined, and DHS has agreed to work with the CSW to monitor for any issues including patient access or delays in care.
The CSW would like to extend our appreciation to Representative Moses for assisting with the setting up of the meeting with DHS and hosting it in his assembly office.
Please look for additional updates from the CSW including upcoming educational programs — not only regarding the changes, but also on how to properly document medical necessity to assist our members with any pre-authorization requests that may be required.
Sincerely,
Steven Conway DC, Esq.
CSW Executive Director