Policy & oversight
Congress Weighs Repealing CMS's New Prior Authorization Pilot in Original Medicare
Six months into a six-year experiment requiring prior authorization for certain services in six states, lawmakers have invoked a law that could shut it down.
By the Goodsurance editorial teamJuly 8, 2026
The Centers for Medicare and Medicaid Services launched the Wasteful and Inappropriate Service Reduction (WISeR) Model on January 1, 2026, requiring prior authorization for a group of outpatient services in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. The model uses AI-assisted review to screen requests for procedures CMS considers vulnerable to waste, fraud, or abuse, including skin and tissue substitutes, electrical nerve stimulators, and epidural spinal injections.
Traditional Medicare has historically not required prior authorization for services. WISeR changes that for beneficiaries in the six pilot states through December 31, 2031.
Original Medicare now requires prior authorization for certain services in 6 states. Congress is debating whether to undo it.
On May 12, 2026, the Government Accountability Office determined that WISeR qualifies as a rule under the Congressional Review Act, allowing Congress to vote on repealing it. Eight days later, Democratic senators and House members introduced Senate Joint Resolution 198 to void the model.
A KFF analysis found that services targeted by WISeR represent a notable share of Part B spending in the pilot states, and noted that prior authorization can delay or block care that patients and providers consider medically necessary. CMS has defended WISeR as a necessary check on services with historically high billing irregularity rates. The Senate has not yet voted on the resolution.
In plain words
A new Medicare program called WISeR started January 1, 2026. It is being tested in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. In those states, doctors must get permission before doing certain procedures for people on Original Medicare. Original Medicare did not used to require that. In May 2026, a government watchdog called the GAO said WISeR counts as a formal rule, meaning Congress can vote to cancel it. A group of lawmakers introduced a measure to do just that. Some say WISeR helps stop waste and fraud. Others say it can delay care patients really need. The Senate has not voted yet.
Understand the basics first
Source: Congress.gov
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