Important News on the Prior Authorization Front: My Choice Wisconsin Removes Physician Prior Authorization Requirement for many Home and Facility Based Services under Family Care Partnership and Medicare Dual Advantage
On Monday, March 2nd, My Choice Wisconsin issued notice that effective April 1, 2026, My Choice Wisconsin will no longer require prior authorization for the visiting physician service codes listed in the notice for in-network Family Care Partnership and Medicare Dual Advantage. All out-of-network visiting physician service codes will still need prior authorization.
This is certainly welcome news that did not occur “overnight”. It is the culmination of almost five months of discussion between My Choice Wisconsin, WHCA/WiCAL and several members, and our business partner, Oak Medical.
We especially want to thank these people for all of their time and commitment to achieving this result:
- Joe Dietlin, VP Network and Operations, and his team at My Choice Wisconsin: Joe and his team took the time to listen and learn how care is delivered each day in a nursing home and assisted living setting. At the end of the day, they agreed that it was best for the resident to receive physician services in the facility whenever possible;
- Tina Belongia, Chief Clinical Officer, North Shore Health, and Mindy Strese, VP of Clinical Operations, Dove Healthcare: Tina and Mindy brought the issue to WHCA/WiCAL staff’s attention and persuasively advocated for change;
- Teresa Larson, CEO, Oak Medical: Teresa also brought this very important issue to staff’s attention and worked tirelessly for change.
Working together, we comprehensively and successfully addressed the issue always with residents’ welfare as the priority.
Questions? Please do not hesitate to contact Kate Dickson, SVP of Reimbursement Policy, kate@whcawical.org or Rick, rick@whcawical.org.
