Overview

• CMS plans to test an AI-assisted prior authorization model called WISeR in six states for Original Medicare starting January 2026.
• Seventeen House Democrats led by Reps. Suzan DelBene and Ami Bera have formally urged CMS Administrator Mehmet Oz to cancel the pilot and release detailed plans and beneficiary safeguards.
• The demonstration partners with private firms, including Medicare Advantage plans, and rewards technologies based on their effectiveness in cutting spending, raising fears of perverse incentives to deny care.
• Lawmakers and advocates cite a Kaiser Family Foundation analysis showing about 81% of prior-authorization denials were reversed on appeal to argue the practice can improperly block necessary treatments.
• CMS has maintained the pilot’s schedule despite requests for suspension, drawing continued scrutiny from Congress and medical groups over patient access and provider burden.