A key legislative panel voted Tuesday to bar the Centers for Medicare & Medicaid Services from spending funds on a controversial prior authorization pilot.
In an amendment added to the broader appropriations bill for the Department of Health and Human Services after a unanimous vote, the House Appropriations Committee determined that "none of the funds made available in this Act or any other Act" should be used to implement the Wasteful and Inappropriate Services Reduction (WISeR) model, or another model that would add prior auth to traditional Medicare.
The 2027 appropriations bill will undergo further congressional review on the way to final passage, and was unveiled in its initial form on June 4.
The WISeR model, unveiled in June 2025, implements a "streamlined" prior authorization process for Medicare, and leans on artificial intelligence. The program was rolled out as part of the feds' broader push to root out fraud, waste and abuse.
CMS unveiled WISeR just days after securing a key commitment from insurers to ease prior authorization burdens.
WISeR drew a swift and negative reaction from provider organizations such as the American Hospital Association and American Medical Association. It's also faced pushback in Congress, with Democratic lawmakers introducing a bill in May that would overturn the program.
In that bill, legislators would call on the Congressional Review Act, arguing that the model should have been submitted to Congress for review before implementation.
Through the amendment, the committee added that it "notes concern" that the model will "create burdens and delays for patients and providers."
"The Committee believes that any proposal to impose prior authorization requirements in traditional Medicare should be subject to robust congressional oversight and transparent evaluation of impacts on beneficiary access to care, provider burden, and program costs," per the amendment.
Per the amendment, the committee is urging CMS to provide details in the fiscal year 2028 congressional justification on the pilot's impact and how the agency selected states for participation.