A House Appropriations subcommittee voted June 9 to block federal funding for the Centers for Medicare & Medicaid Services’ first-of-its-kind artificial intelligence prior-authorization pilot in traditional Medicare, escalating a bipartisan congressional challenge to a program that has drawn criticism from patient advocates, physicians, and lawmakers on both sides of the aisle.
The amendment, adopted by voice vote during the full committee’s fiscal year 2027 Labor-HHS spending bill markup, would bar any appropriated funds from being used to implement the Wasteful and Inappropriate Service Reduction model — known as WISeR — or any similar model that adds prior-authorization requirements to traditional Medicare. Subcommittee Chair Robert Aderholt (R-AL) characterized the amendment as bipartisan; Rep. Lois Frankel (D-FL) said she developed it alongside Rep. Andy Harris (R-MD).
What WISeR does. Launched on January 1, 2026, WISeR contracts with private technology vendors to conduct AI- and machine-learning-powered pre-payment review of select Part B services in six states: Arizona, Washington, New Jersey, Texas, Ohio, and Oklahoma. The model runs for six performance years through December 31, 2031. Thirteen service categories are currently active — including bioengineered skin substitutes, epidural steroid injections, several classes of implanted nerve stimulators, arthroscopic knee debridement for osteoarthritis, and cervical spinal fusion — services that CMS says carry elevated risk of waste, fraud, and inappropriate use. AI flags requests for human clinical review; all denials must be reviewed by a licensed clinician, with standard requests processed within three days and urgent requests within two. Notably, vendors are compensated not by flat fee but as a percentage of savings from services denied or diverted, an incentive structure critics have argued creates a financial bias toward refusal.
According to KFF analysis, roughly 1.1 million traditional Medicare beneficiaries nationwide received at least one WISeR-covered service in 2024, with those in the six pilot states now subject to prior authorization.
The GAO determination. Congressional opposition intensified after the Government Accountability Office concluded on May 12, 2026 that WISeR constitutes a rule under the Administrative Procedure Act and is therefore subject to the Congressional Review Act’s submission requirements — a finding that opened a formal legislative path to repeal. Senate and House Democrats had separately introduced joint resolutions of disapproval following that determination.
What the committee said. The amendment’s language states 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.”
What comes next. The FY2027 HHS spending bill must still pass the full House and then clear the Senate before any funding prohibition could take effect. WISeR continues to operate in the meantime. A parallel amendment passed the same committee during the FY2026 spending process but did not survive into final legislation, a precedent that leaves the program’s long-term fate uncertain.