Bill

United States: Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services of the Department of Health and Human Services relating to "Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model".

This joint resolution prohibits the Centers for Medicare & Medicaid Services (CMS) from testing a new Medicare payment model in certain states that involves a prior authorization process and the use of enhanced technology by third-party contractors to determine whether certain claims should be paid. Specifically, the joint resolution nullifies a notice issued by the CMS on July 1, 2025, titled Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model . (On May 12, 2026, the Government Accountability Office issued a letter of opinion stating that this notice constituted an agency rule and is therefore subject to the Congressional Review Act.) The CMS selected six states to participate in this model over a six-year period: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. Under the model, contracted companies must process prior authorization requests (i.e., requests for coverage determinations before a service is furnished) for certain services using enhanced technology (e.g., artificial intelligence). Contracted companies are paid based on the share of resulting savings. The CMS aims to test the model's ability to produce accurate results while streamlining the prior authorization process for Medicare claims. The model is based in part on similar processes used for Medicare Advantage claims. CMS began implementing the model on January 1, 2026. This joint resolution prohibits the CMS from continuing to do so.

• In force
• Not yet reviewed
• English

Open the source (opens in a new tab) Suggest a correction