Goodsurance

Policy & oversight

Senate Votes 50 to 46 to Keep CMS Artificial Intelligence Prior Authorization Pilot Running in Traditional Medicare

A Congressional Review Act resolution to nullify the CMS WISeR model failed on July 16, allowing an AI-assisted prior authorization program for original Medicare to continue in six states.

By the Goodsurance editorial teamJuly 16, 2026

On July 16, 2026, the United States Senate voted to preserve the Centers for Medicare and Medicaid Services Wasteful and Inappropriate Service Reduction model, known as WISeR. A procedural vote on Senate Joint Resolution 198, a Congressional Review Act resolution to overturn the program, failed 46 to 50, with 50 senators voting against advancing it.

Democrats sponsored the resolution after the Government Accountability Office ruled in May 2026 that the CMS implementation notice for WISeR qualified as a rule subject to congressional review. Supporters of the resolution argued that the AI system could delay or deny medically necessary care for traditional Medicare beneficiaries without adequate consumer protections.

WISeR launched January 1, 2026 as a six-year pilot in six states: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. Under the model, CMS partners with vendors that use AI and machine learning to conduct prior authorization reviews for services identified as carrying higher risk of fraud, waste, or abuse in fee-for-service Medicare. Any non-affirmation decision must be reviewed by a licensed clinician before it stands.

Traditional Medicare historically has operated without prior authorization requirements. WISeR is the first program to bring AI-assisted utilization review into original fee-for-service Medicare at scale. The Medicare Rights Center urged Congress on July 16 to protect beneficiary access to care, warning that AI-driven reviews can hinder access for people who need treatment. With the resolution defeated, the pilot continues while broader debates about AI oversight in Medicare proceed.

In plain words

The Senate voted on July 16, 2026 to keep a Medicare program running that uses AI and computers to review some medical claims before Medicare pays for them. The program works in six states right now. Forty-six senators tried to stop it, but they did not get enough votes. Fifty senators voted to keep it going. Some people worry the AI might wrongly say no to care that patients need. Others say the program helps stop waste and fraud in Medicare. If you have traditional Medicare and live in New Jersey, Ohio, Oklahoma, Texas, Arizona, or Washington, some medical services may require approval before Medicare covers them.

Source: Medicare Rights Center
Read at the source →

More news

Other stories on what is moving in Medicare.

Policy & oversight

OIG Found More Than 15 Million Dollars in Medicare Payments Where Emergency Room Billing Codes Were Used at Non-Emergency Sites

A March 2026 federal audit identified improper and potentially improper Medicare payments made when physicians and hospitals used emergency department billing codes for care not actually delivered in an emergency department, and found that Medicare lacked automated safeguards to catch the mismatches.

August 8, 2026

Policy & oversight

Federal Audit Found at Least 4.7 Million Dollars in Medicare Overpayments at an Arkansas Hospital

An OIG audit of Jefferson Regional Medical Center found a high rate of billing errors on claims flagged as elevated risk, producing an estimated 4.7 million dollars in improper Medicare payments. The hospital disputed most of the findings.

August 7, 2026

Policy & oversight

CMS Publishes Plan to Speed Medicare Coverage for Breakthrough Medical Devices

A new pathway would give FDA-cleared breakthrough devices a national Medicare coverage decision within weeks of regulatory approval, rather than waiting years under the standard process.

August 7, 2026

Policy & oversight

Federal Audit Found 97 Cybersecurity Gaps in Medicare Billing Contractors for Fiscal Year 2024, Though the Most Serious Deficiencies Declined

An OIG annual report to Congress found information security deficiencies across all seven Medicare administrative contractors in fiscal year 2024, while noting that high-risk and moderate-risk gaps fell compared with the prior year.

August 6, 2026

Policy & oversight

CMS Published Second-Quarter 2026 Drug Coding Decisions That Shape How Medicare Identifies and Pays for New Medicines

The quarterly HCPCS drug coding update, posted July 29 and highlighted in the August 6 MLN Connects newsletter, determines which new medications and biologicals get a dedicated Medicare billing code.

August 6, 2026

Policy & oversight

CMS Sets a Sunset Date for the NTAP Alternative Track for Breakthrough Devices and Advances the RAPID Pathway

The fiscal year 2027 hospital payment final rule phases out the alternative NTAP track that breakthrough-designated devices used to qualify for Medicare reimbursement, while a new CMS-FDA program called RAPID is positioned to take its place.

August 5, 2026