Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services of the Department of Health and Human Services relating to “Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model”.
Key claim: A congressional joint resolution would nullify CMS’s WISeR Model, which requires third-party contractors using enhanced technology including AI to perform prior authorization on select Medicare services in six states and pays them based on savings.
Abstract
(HJRES187 · 119th Congress) This joint resolution prohibits the Centers for Medicare & Medicaid Services (CMS) from testing a new Medicare payment model in certain states that involves a prior authorization process and the use of enhanced technology by third-party contractors to determine whether certain claims should be paid. Specifically, the joint resolution nullifies a notice issued by the CMS on July 1, 2025, titled Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model . (On May 12, 2026, the Government Accountability Office issued a letter of opinion stating that this notice constituted an agency rule and is therefore subject to the Congressional Review Act.) The CMS selected six states to participate in this model over a six-year period: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. Under the model, contracted companies must process prior authorization requests (i.e., requests for coverage determinations before a service is furnished) for certain services using enhanced technology (e.g., artificial intelligence). Contracted companies are paid based on the share of resulting savings. The CMS aims to test the model’s ability to produce accurate results while streamlining the prior authorization process for Medicare claims. The model is based in part on similar processes used for Medicare Advantage claims. CMS began implementing the model on January 1, 2026. This joint resolution prohibits the CMS from continuing to do so. Latest action (2026-05-19): Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Why this matters
A Congressional Review Act joint resolution targeting the WISeR Model is one of the first legislative attempts to roll back a federal program that operationalizes AI in benefits adjudication with a savings-based contractor payment structure. The outcome shapes whether shared-savings, AI-assisted utilization management becomes a template for other federal payers, and signals congressional appetite to police executive-branch deployment of AI in high-stakes coverage decisions.