YourVoice.Now Summary
Your MoneyCorporate BenefitsTransparency & AccountabilityWould end a new step where traditional Medicare must okay certain care first — in six states.
Your Money
Since January 2026, doctors in six states must get Medicare's okay before certain care. Steroid shots for back pain and spine fusion are on the list. This measure would end that step, so claims would be checked after the care.
Private firms hired by Medicare use AI and other tools to screen these requests. A doctor or other licensed clinician must sign off before a request is turned down.
Corporate Benefits
The firms running these reviews earn a cut of the money Medicare does not end up spending. Ending the test would end that pay deal, which was set to last through 2031.
Transparency & Accountability
A rule that Congress cancels cannot come back in nearly the same form. Only a new law can revive it. In May 2026, the GAO watchdog office ruled this Medicare notice counted as such a rule.
More about this bill
If you have traditional Medicare in one of six states, an extra approval step would end. Since January 2026, doctors there must get Medicare's okay first for about 15 kinds of care. The list covers nerve stimulators, steroid shots for back pain, spine fusion, and knee scopes. The six states are New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. This measure would cancel that test, called the WISeR Model. Under it, private firms hired by Medicare screen the requests with computer tools, including AI. Those firms are paid a share of the money Medicare does not spend. The test was set to run through 2031. Congress can cancel agency rules like this one. If that happens, the agency cannot bring the rule back without a new law.
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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