House Committee Votes to Block Medicare AI Prior Authorization Pilot
The House Appropriations Committee voted unanimously Tuesday to strip funding for a Medicare prior authorization pilot that uses artificial intelligence to review certain medical services. The amendment targets the WISeR program, which launched in six states in January and has drawn criticism from patient advocates and lawmakers for delaying care to seniors.
The measure would prevent the Centers for Medicare & Medicaid Services from using federal funds to implement WISeR or any similar prior authorization model in traditional Medicare. It still requires approval from the full House and Senate before becoming law.
What WISeR Does
CMS introduced the Wasteful and Inappropriate Service Reduction model last summer to combat what the agency called fraud and wasteful spending. The program contracts with private companies to add AI-enabled prior authorization for services deemed vulnerable to inappropriate use, including skin and tissue substitutes and epidural steroid injections for pain management.
Bipartisan Opposition
The amendment reflects growing concern about the pilot across party lines. Rep. Robert Aderholt, R-Ala., who chairs the subcommittee overseeing the Department of Health and Human Services, called the amendment "bipartisan" during the markup.
Rep. Lois Frankel, D-Fla., said the effort resulted from collaboration with Rep. Andy Harris, R-Md. "Medicare was built on a simple promise that after a lifetime of work Americans should be able to get the healthcare they have earned," Frankel said. "And prior authorization by artificial intelligence is putting the judgement of doctors and the needs of patients behind."
Earlier Legislative Efforts
House Democrats introduced a bill to repeal WISeR late last year, though it has not advanced. In May, Democrats in both chambers introduced resolutions to roll back the pilot using a legislative tool that allows Congress to overturn agency actions.
For healthcare professionals navigating the evolving role of AI for Healthcare, understanding these policy developments is essential as they shape how technology gets deployed in patient care.
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