This resolution would cancel a federal rule from the Centers for Medicare & Medicaid Services (CMS) that created the Wasteful and Inappropriate Services Reduction (WISeR) prior-authorization model. Under the CMS rule, Medicare would have required prior approval for select services before covering them, a step meant to cut down on unnecessary or wasteful care. Congress can use the Congressional Review Act to disapprove recently issued agency rules, and this resolution invokes that power after the Government Accountability Office concluded the WISeR notice qualifies as a formal rule subject to review. If adopted, the rule would have no legal force, meaning CMS could not implement the new prior-authorization requirements for the affected Medicare services. The change would directly affect Medicare beneficiaries and the providers who bill Medicare for the services in question.
Average Household Impact
- Medicare prior-authorization requirement — Nullified for select services under the CMS WISeR pilot model
Congressional Summary
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.
Details
- Congress
- 119th
- Chamber
- House
- Status
- summarized
- Action
- Introduced in House
- Action Date
- 2026-05-19
- Date Added
- 2026-07-18
- Source
- Congress.gov →
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