06/16/2026

CMS Innovation Center AI Prior Authorization Model is Under the Microscope 

The Centers for Medicare & Medicaid Services (CMS) launched a pilot program called the Wasteful and Inappropriate Service Reduction (WISeR) on January 1, 2026, in six states to test the use of enhanced technologies, including artificial intelligence (AI), in reviewing and making determinations on select prior authorization requests in traditional Medicare.

The model has drawn criticism from stakeholders who argue that it could delay access to medically necessary care, increase administrative burden, and create financial incentives that may encourage denials. Adding momentum to the critics’ concerns, the Government Accountability Office (GAO) recently determined that the WISeR model is subject to the Congressional Review Act, triggering a 60-day window during which Congress may consider a resolution of disapproval to overturn the model. Joint resolutions have been introduced in both the House and the Senate. Furthermore, the FY 2027 House Labor, Health and Human Services and Education appropriations bill includes language blocking CMS from spending congressionally appropriated funding on this model. It also requests that CMS provide an update in the next year on how the model has impacted patients. 

ASH is monitoring the model and related legislation and will keep members updated.