Democrats ramp up efforts to repeal Medicare prior authorization pilot

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Democratic lawmakers have introduced resolutions in the House and Senate to overturn CMS’ Wasteful and Inappropriate Services Reduction (WISeR) model, an AI-assisted prior authorization initiative under traditional Medicare.

The effort follows a May 12 determination from the Government Accountability Office that WISeR qualifies as a rule subject to congressional disapproval under the Congressional Review Act, opening a 60-day window for lawmakers to force votes on repealing the program.

CMS launched WISeR at the start of 2026, with plans to run the model through the end of 2031 in Washington, New Jersey, Ohio, Oklahoma, Texas and Arizona. The model applies prior authorization requirements to select traditional Medicare services and relies on for-profit contractors using AI tools to process requests and reviews. Participating contractors are compensated based on a share of “averted expenditures,” which some lawmakers have argued creates incentives to deny care.

Democrats have attempted to block WISeR through multiple legislative avenues since CMS announced the model last June, including appropriations amendments and standalone legislation, without success. 

For the resolutions to take effect, both chambers would need to pass them and the president would need to sign them into law.

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