WISeR Update: Congress Seeks to Block Model

The House Appropriations Committee voted to block CMS from using fiscal year 2027 funding for the Wasteful and Inappropriate Services Reduction (WISeR) Model or similar demonstrations. The 2027 appropriations bill will undergo further congressional review before it can advance.

WISeR has sparked controversy since its announcement last summer. Concerns have been raised about its use of prior authorization in Traditional Medicare (which has largely been used in the Medicare Advantage environment); its use of AI to conduct prior authorization reviews; and its incentive structure, which has been described as rewarding contractors for denying care.

Despite significant opposition to this model from Congress and stakeholders, CMS has been very bullish on it and views it as a way to address waste and improve efficiency in the Medicare program. The agency has indicated that insights from this model could be applied to other states or medical services and that the model could be expanded in the future. I believe CMS will continue to defend and promote this model, which it views as clearly aligned with its stated goals and priorities.

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For more information and questions, please contact:

Sheila Madhani

Madhani Healthcare Consulting

Email: smadhani@madhani-health.com

Tel: (202) 679-2977