Today, Representatives Suzan DelBene (WA-01), Lois Frankel (FL-22), Kim Schrier, MD (WA-08), Lloyd Doggett (TX-37), Mark Pocan (WI-02), Greg Landsman (OH-01), Ami Bera, MD (CA-06), Rick Larsen (WA-02), Alexandria Ocasio-Cortez (NY-14), and Jan Schakowsky (IL-09), along with 62 colleagues, urged House and Senate leadership to include language that would prohibit the implementation of new prior authorization requirements through artificial intelligence claims review in traditional Medicare in any final Fiscal Year 2026 (FY26) funding agreement.

The Centers for Medicare and Medicaid Services' (CMS) Wasteful and Inappropriate Service Reduction (WISeR) model began January 1, 2026, in New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. The model adds new red tape to traditional Medicare by contracting with private companies that use artificial intelligence to require prior authorization for certain services and treatments, including treatments for chronic pain, Parkinson's disease, sleep apnea, and wound care.

"While we support innovation, efficiency, and eliminating waste, we are concerned that this pilot will delay care for essential services to treat pain, injuries, and chronic conditions," the Members wrote in a letter to House and Senate leadership.

Concerns about prior approval are well-documented in Medicare Advantage and other private health plans. Federal watchdogs have found that insurers often deny care that later meets Medicare's coverage rules, forcing patients and providers to navigate appeals, paperwork, and delays before care can move forward.

"These denials delay patient access to care while creating unnecessary administrative burdens for providers," the lawmakers added.

Last August, DelBene and 16 other colleagues raised similar concerns directly with CMS and requested details about how the model would be carried out and how patients would be protected from delayed or denied care. CMS did not respond and has since moved forward with implementation despite these unresolved concerns. DelBene also introduced legislation to help seniors get the care they need when they need it by reforming prior authorization in Medicare Advantage.

Last September, the House Appropriations Committee unanimously adopted an amendment offered by Frankel to halt the implementation of WISeR in the Labor-HHS funding bill.

The full letter can be found here.