CMS WISeR Model Introduces Gold Carding Exemptions in Texas

APMA recently received a positive update regarding implementation of the CMS Wasteful and Inappropriate Services Reduction (WISeR) Model. Cohere Health, the model participant administering WISeR in Texas, has begun notifying providers who qualify for its new "gold carding" program. Beginning July 7, eligible providers will be exempt from prior authorization and pre-payment review requirements for WISeR services for one year. Eligibility is based in part on maintaining a prior authorization approval rate of at least 90 percent.

While APMA remains opposed to the WISeR Model and the expansion of prior authorization in Medicare, the association has consistently advocated for a gold carding approach that reduces administrative burden for providers who demonstrate a strong record of appropriate utilization and compliance. In comments submitted to CMS last year, APMA specifically urged the agency to move forward with gold carding as quickly as possible.

APMA will continue to advocate for policies that reduce administrative burden while protecting patient access to medically necessary care.

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