Sen. Maria Cantwell, D-Wash., is calling on HHS Secretary Robert F. Kennedy Jr. to overhaul CMS’ new AI-driven prior authorization program for traditional Medicare, citing delays in care and increased burdens on patients and providers.
In an April 27 letter to Mr. Kennedy, Ms. Cantwell called for changes to the Wasteful and Inappropriate Service Reduction Model, a pilot program launched Jan. 1 across six states. The program requires Medicare patients in Arizona, New Jersey, Oklahoma, Ohio, Texas and Washington to obtain prior authorization for 13 types of procedures or treatments through an AI-based system.
Ms. Cantwell said the program is not meeting CMS benchmarks and is creating burdens for patients and providers. According to the letter, she wrote that while CMS committed to responding to claims within 72 hours, providers in Washington report waiting 15 to 20 days, with many determinations resulting in denials without clear justification. Procedures that once took about two weeks to complete are now taking four to eight weeks, forcing patients to reschedule care and potentially worsening their conditions.
She also warned that the model’s structure may incentivize delays and denials. In the letter, Ms. Cantwell said the program “financially rewards contractors for delaying or denying care,” which she argued risks restricting access for seniors.
Ms. Cantwell called on HHS to implement several changes, including enforcing 72-hour response times for standard claims, requiring human-reviewed explanations for denials, increasing public reporting on denial rates and contractor financial gains and preventing denials when a patient’s care team has ruled out alternatives.
A snapshot report from Ms. Cantwell’s office found patients are waiting two to four times longer for recommended care under the program.
Ms. Cantwell also raised the issue during an April 22 Senate Finance Committee hearing, where Mr. Kennedy said such delays are “unacceptable” and pledged to work with her to address them.
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