On May 20, 2026, Congressional Democrats led by Senators Ron Wyden (D-OR), Rep. Suzan Delbene (D-WA), and Rep. Greg Landsman (D-OH) introduced a resolution to repeal the Centers for Medicare & Medicaid Services’ (CMS) Wasteful and Inappropriate Service Reduction (WISeR) model via the Congressional Review Act (CRA). If certain requirements are met, the resolution could come to a vote by July 11th with immunity from a Senate filibuster.
Last year, the Medicare Policy Initiative published a blog summarizing the requirements of the six-year WISeR model, as well as concerns about potential harm to patients. In short, WISeR aims to reduce unnecessary, duplicative, and “low-value” care in Traditional Medicare by 1) introducing prior authorization requirements to a subset of items and services in Traditional Medicare, and 2) leveraging enhanced technologies—including artificial intelligence (AI)—in the prior authorization process. CMS is currently testing the model in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington.
While there is widespread recognition that prior authorization can be effective in reducing “wasteful” care, it can also lead to denials and delays of critical care, as well as significant out-of-pocket expenses for patients when they receive services that their insurer declines to cover after the fact. In addition, health plans in the Medicare Advantage (MA) program are already using AI in the prior authorization process, with some MA plans contending that AI tools aid in clinical decision making and reduce administrative burden. Some reports have found that using AI can lead to high denial rates and worsen health disparities, however. Medicare advocacy groups have also argued that MA prior authorization decisions have been made solely by AI tools and decried a lack of transparency.
CMS officially implemented the WISeR model on January 1, 2026, partnering with six companies to implement its prior authorization requirements. In this blog, we detail the key actions that led to the CRA resolution and provide updates on the WISeR model since its formal introduction.
Congressional Pushback on the WISeR Model Prior to Implementation
In July 2025, Reps. Alexandria Ocasio-Cortez (NY-14) and Lloyd Doggett (TX-37), along with 40 of their colleagues, sent a letter to CMS urging the agency to halt implementation of the WISeR model, citing concerns similar to those previously discussed. In response, CMS issued a list of Frequently Asked Questions (FAQs) that clarify certain aspects of the model. The FAQs emphasize that WISeR does not change Medicare coverage or payment of the included services. CMS also stated that Participants (i.e., companies conducting prior authorizations under the model) would be financially penalized for inappropriate denials and that providers and beneficiaries would maintain the right to appeal denied claims.
However, the FAQs did not fully address concerns raised by some Members of Congress and stakeholder organizations. In November 2025, Reps. Delbene (WA-01), Landsman (OH-01), Bera (CA-06), Schrier (WA-08), Pocan (WA-02), and Larsen (WA-02) introduced legislation that would have prohibited CMS from implementing the WISeR model. The House Appropriations Committee also adopted an amendment to the Fiscal Year 2026 Labor, Health and Human Services, Education, and Related Agencies (LHHS) Appropriations bill that would have withheld appropriations funding for the model, but this amendment was not included in the final Act that was signed into law.
Despite this opposition, CMS moved forward with implementation, announcing the six model participants in December 2025:
- Cohere Health, Inc. as the vendor for Texas
- Genzeon Corporation as the vendor for New Jersey
- Humata Health, Inc. as the vendor for Oklahoma
- Innovaccer Inc. as the vendor for Ohio
- Virtix Health LLC as the vendor for Washington
- Zyter Inc. as the vendor for Arizona
Early Implementation: Anecdotal Reports of Technical Challenges and Low Approval Rates
Due to technical issues, the WISeR model became effective on January 15th, 2026 rather than January 1st. Following implementation, some providers reported problems with online portals, technical glitches, and communication with model participants. The Washington Post reported that, in Texas, approximately 62% of prior authorization requests received initial approval. The approval rate increased to 84% after a physician review following initial non-authorization. This is lower than reported approval rates for prior authorization requests in MA, which often exceed 90%, although rates vary across services and plans. These figures also reflect a limited period of implementation in a single state and may not be representative of overall model performance. Other analyses suggest the impact of the WISeR model may be more modest, partially because WISeR services account for a small percentage of Medicare Part B spending and relatively few beneficiaries use these services.
The Speed of Implementation Leads to a Lawsuit and Modifications to the Model
In March 2026, the Electronic Frontier Foundation, a digital and privacy rights nonprofit, filed a Freedom of Information Act lawsuit against CMS seeking additional information about the technologies and AI tools being used by model participants. In April 2026, CMS announced it would delay the implementation of two services under the WISeR model “to allow additional time for operational readiness”: Deep Brain Stimulation for essential tumors and Parkinson’s disease as well as Percutaneous Image-Guided Lumbar Decompression for spinal stenosis.
Democrats Invoke the Congressional Review Act
While CMS continued implementation of the model, Democrat-led congressional scrutiny also intensified. A series of oversight efforts culminated in a Government Accountability Office (GAO) determination that WISeR constitutes a rule for purposes of the CRA.
Under the CRA, federal agencies are required to submit rules to Congress before they can take effect. If an agency fails to submit a rule to Congress, Congress may take certain special procedures to repeal the rule or stop the rule from going into effect. This process is generally triggered when Members of Congress request that the GAO produce a formal opinion as to whether an agency’s action satisfies the definition of a rule. A GAO determination may trigger the CRA’s expedited procedures for a joint resolution of disapproval, which can be used to repeal a rule or prevent it from taking effect.
In December 2025, Senators Wyden, Murray, Gillibrand, and Blumenthal sent a letter to the GAO requesting it determine whether the WISeR model constitutes a rule. On May 12, 2026, the GAO concluded that the WISeR model meets the Administrative Procedure Act definition of a rule since, among other things, the model prescribes new requirements for Traditional Medicare providers in certain states by mandating prior authorization for certain services.
Congressional Democrats Introduce Joint Resolutions of Disapproval to Repeal WISeR
As a result of GAO’s determination, Senate and House Democrats separately introduced joint resolutions of disapproval. Senator Ron Wyden (D-OR) sponsored the resolution in the Senate, while Reps. Suzan DelBene (D-WA.) and Greg Landsman (D-OH) introduced the resolution’s House counterpart. Both resolutions have attracted numerous Democratic co-sponsors.
Under the CRA, Congress has a limited 60-day period following a GAO determination during which Members may seek expedited consideration of a joint resolution of disapproval, and the joint resolution may be filibustered in the Senate, if the Members meet certain requirements. If the resolution passes both chambers of Congress and is signed by the President, CMS would be required to terminate the model.
Conclusion
The WISeR model remains one of the most closely watched demonstrations currently underway at CMS. Five months into implementation, the available evidence remains limited. Early reports suggest that some providers have experienced technical challenges and lower-than-expected approval rates, while CMS has already modified certain aspects of the model by delaying implementation for select services. At the same time, questions remain regarding the technologies used by model participants, the model’s payment incentives, and its overall impact on beneficiary access to care.
The recent GAO determination and subsequent CRA resolutions have introduced a new level of uncertainty regarding the model’s future. While it remains unclear whether Congress will vote to repeal the model, these recent developments underscore broader questions surrounding the model’s future. The model ultimately raises broader policy questions about the role and future of prior authorization, artificial intelligence, and utilization management tools in Medicare.