This resolution would block a Medicare rule from taking effect that let the Centers for Medicare & Medicaid Services (CMS) test a new prior-authorization system, called the WISeR Model, for certain services under traditional Medicare. Prior authorization means a health provider must get government approval before Medicare will pay for a service; the blocked rule would have applied this extra approval step to a set of specific procedures for original Medicare enrollees, a group that has not historically faced prior-authorization hurdles the way Medicare Advantage enrollees do. The Government Accountability Office determined in May 2026 that the CMS notice legally counted as a 'rule' subject to congressional review. Under this resolution, the rule would have no legal force, meaning CMS could not proceed with the prior-authorization requirement as written.
Average Household Impact
- Medicare prior-authorization rule — WISeR model blocked from taking effect for select services
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
- Senate
- Status
- summarized
- Action
- Introduced in Senate
- Action Date
- 2026-06-24
- Date Added
- 2026-07-18
- Source
- Congress.gov →
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