Congressional Opposition to WISeR Model Demands Performance Data From CMS

A congressional coalition sent a letter on June 22 to Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz, M.D., expressing their collective concerns about the implementation of the Center for Medicare and Medicaid Innovation Wasteful and Inappropriate Service Reduction (WISeR) model.

The WISeR model utilizes artificial intelligence to automate prior authorization in traditional Medicare. Since its initial implementation on Jan. 1, 2026, the undersigned members claim, “patients and providers in the affected states have reported care denials, long wait times, and increased administrative burden.”

The program is currently scheduled to run until Dec. 31, 2031, and only applies to providers and patients in New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington.

According to the letter, CMS has not released comprehensive data on the WISeR model’s implementation. The coalition formally requested answers to several questions by July 15 to allow members of Congress to conduct adequate oversight of the program. Specifically, the coalition has requested:

• Data for each participating state regarding prior authorization decisions, turnaround times following claims submissions, and total time from initial WISeR submission to final claim payment.
• Data for each participating state regarding access to peer-to-peer clinical review after a claim is not affirmed or denied.
• Answers to key questions regarding oversight of participants to prevent inappropriate denials and ensure accuracy of determinations:
  • When will the first audit of the WISeR model be publicly released?
  • What are the performance metrics and benchmarks CMS will use to determine whether to terminate participating vendors?
  • Is CMS planning to evaluate impacts of increased administrative burden on providers subject to the WISeR model?
  • How will CMS determine the success of each vendor in the model?

Source:

https://delbene.house.gov/uploadedfiles/final_wiser_letter_june_2026.pdf