Democrats move to overturn WISeR

Senate and House Democrats moved on May 20 to overturn the Centers for Medicare & Medicaid Services’ WISeR model, a Medicare prior-authorization program that uses artificial intelligence and human clinical review for selected services. The push followed a May 12 ruling from the Government Accountability Office that said the WISeR notice qualifies as a rule under the Congressional Review Act. That finding gives Congress a procedural route to file a joint resolution of disapproval. CMS launched WISeR on January 1 in six states and says the model is intended to speed review of certain services while reducing waste. ### Why are Democrats trying to use the Congressional Review Act here? GAO said on May 12 that CMS’s July 1, 2025 WISeR notice is a rule for purposes of the Congressional Review Act because it sets new requirements for Original Medicare providers in selected states and can affect claim determinations for beneficiaries. GAO said no CRA exception applies, which means the notice should have been submitted to Congress before taking effect. (fiercehealthcare.com) Fierce Healthcare reported that Sens. Ron Wyden, Maria Cantwell, Richard Blumenthal and Kirsten Gillibrand introduced the Senate resolution, while Reps. Suzan DelBene and Greg Landsman introduced a House companion. Fierce said lawmakers now have 60 days to force a vote on the disapproval measure after the GAO determination. (gao.gov) CRS says a CRA joint resolution, if passed by both chambers and signed by the president or enacted over a veto, bars the rule from taking effect or continuing in effect. CRS also says the CRA can apply to agency actions beyond traditional notice-and-comment rules. ### What exactly is WISeR? CMS says WISeR stands for Wasteful and Inappropriate Service Reduction. (fiercehealthcare.com) The agency says the model “leverag[es] enhanced technologies, such as Artificial Intelligence (AI) and Machine Learning (ML), along with human clinical review” to review select items and services in Original Medicare. CMS says the model is voluntary and is scheduled to run for six performance years, from January 1, 2026 through December 31, 2031, in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. (congress.gov) The agency says the program targets services it views as vulnerable to fraud, waste and abuse and is meant to reduce clinically unsupported care. (cms.gov) Fierce Healthcare reported that the model covers 13 medical services and was described by CMS’s Innovation Center as a six-state pilot when it was unveiled last year. ### What are lawmakers and critics saying is the problem? Rep. Suzan DelBene said the model is a “dangerous program that is denying care to Medicare patients so companies can profit,” according to Fierce Healthcare. (cms.gov) She said patients in Washington state had seen conditions worsen while waiting for approval of doctor-prescribed treatments. (fiercehealthcare.com) Fierce also reported that Democrats cast the program as an import of Medicare Advantage-style prior authorization into traditional Medicare. The outlet said provider groups including the American Hospital Association and the American Medical Association have raised concerns about the model. (fiercehealthcare.com) Earlier opposition had already surfaced in Congress. H.R. 5940, introduced in the House on November 7, 2025, would prohibit the HHS secretary from implementing the WISeR model or any substantially similar model. ### What does CMS say in response? CMS says WISeR is designed to protect taxpayers and support “timely and appropriate Medicare payment” for selected items and services. (fiercehealthcare.com) The agency says the model uses enhanced technologies with human clinical review and is intended to decrease costs while easing administrative burden on providers and suppliers that go through prior authorization. (congress.gov) CMS also says the program is meant to encourage “safe and evidence-supported best practices” for people with Medicare. The agency frames the model as a way to reduce low-value care and focus spending on services that improve patient well-being. ### What happens next in Congress? The next step is procedural as much as political. (cms.gov) Fierce Healthcare reported that the GAO determination opened a 60-day window for lawmakers to force votes on the disapproval resolution. Under CRS’s description of the CRA, any successful effort would still need passage in both chambers and presidential approval, unless Congress overrides a veto. CMS’s current timetable remains in place unless Congress stops it. The agency says WISeR is operating in six states now and is scheduled to continue through December 31, 2031. (cms.gov) (fiercehealthcare.com)