Dive Brief:
- A key House committee voted Tuesday to end a pilot program that adds artificial intelligence-backed prior authorization to some services in traditional Medicare.
- The House Appropriations Committee unanimously decided to add an amendment to HHS’ spending legislation for 2027 that would block funds from being used to implement the WISeR pilot or any other model that adopts prior authorization in traditional Medicare.
- The measure would still need to clear several more levels of congressional review, including passing the full House and Senate. But it’s another sign of lawmakers’ concern about WISeR, which has been criticized by patient advocates and Democrats for restricting seniors’ care.
Dive Insight:
The CMS announced the Wasteful and Inappropriate Service Reduction model last summer, as part of a move to crack down on what the agency called fraud and wasteful spending in Medicare.
Under the program, the federal government contracts with private companies to add AI-enabled prior authorization for some services considered vulnerable to inappropriate use, like skin and tissue substitutes and epidural steroid injections for pain management.
WISeR went into effect in six states in January. Democrats quickly railed against the model, arguing it delays care for seniors and adds additional administrative burdens on providers.
Now, the model is receiving more pushback from lawmakers on both sides of the aisle. Rep. Robert Aderholt, R-Ala., who chairs the subcommittee that oversees the HHS, called the sweeping amendment “bipartisan” during the markup on the legislation.
Rep. Lois Frankel, D-Fla., said the amendment was the result of her collaboration with Rep. Andy Harris, R-Md.
“I think we all agree. Medicare was built on a simple promise that after a lifetime of work Americans should be able to get the healthcare they have earned,” she said. “And prior authorization by artificial intelligence is putting the judgement of doctors and the needs of patients behind.”
Late last year, House Democrats introduced a bill to repeal the WISeR model, though the legislation hasn’t advanced. And in May, Democrats in the House and Senate introduced resolutions to roll back the pilot using a legislative tool that Congress can use to overturn agency actions.
