Thirty-one House Democrats are seeking more information on CMS’ Wasteful and Inappropriate Service Reduction model.
The lawmakers sent a letter to CMS Administrator Mehmet Oz, MD, June 22, requesting data on the pilot by July 15.
WISeR harnesses AI to bring prior authorization to traditional Medicare. The model kicked off in six states at the beginning of 2026 and will run through 2031. Some services that are now subject to prior authorization include skin and tissue substitutes, electrical nerve stimulator implants and knee arthroscopy for osteoarthritis.
The lawmakers cited reports of care denials, long wait times and greater administrative load since the launch. The letter also featured statistics from HHS Office of Inspector General reports on prior authorization in Medicare Advantage, including a 2018 report that said 75% of denied prior authorization requests were overturned on appeal. The letter also included recent findings about post-acute care denials.
The authors requested more information about determination turnaround times, denial rates and reasoning, peer-to-peer reviews, claim payment timing, appeals, and overturned decisions. They also sought clarity on when findings from the first WISeR audit would be shared, as well as which benchmarks CMS is using to evaluate vendors.
“CMS has not yet released comprehensive data on the WISeR model’s implementation, leaving impacted patients and providers in the dark, and preventing Congress from conducting appropriate oversight,” the lawmakers wrote.
The letter comes just weeks after the House Appropriations Committee’s 2027 spending bill markup, when it moved forward with an amendment that would block WISeR funding.
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