Becker's Healthcare November 11, 2025
Six Democratic House representatives introduced legislation this month to stop the upcoming Medicare prior authorization pilot, the Wasteful and Inappropriate Service Reduction model.
WISeR would implement prior authorization for traditional Medicare across six states starting next year. CMS said the pilot would leverage companies’ AI tools to expedite reviews.
House Democrats have been vocal over their concerns with the AI use, and the program also received backlash from the American Hospital Association. One sticking point: CMS will pay third parties based on “averted expenditures.”
“As a doctor and former chief medical officer of Sacramento County, I’ve seen how harmful prior authorization can be when it delays or denies necessary care for patients,” Rep....
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