Concord, N.H. – Congresswoman Maggie Goodlander sent a letter alongside 40 of her colleagues to Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz and Deputy Administrator Abe Sutton urging them to reject any efforts to expand the pre-treatment approval process, more commonly known as prior authorization, in Traditional Medicare.
Earlier this year, CMS released plans to implement the Wasteful and Inappropriate Services Reduction (WISeR) pilot, which will require Traditional Medicare providers to obtain approval from for-profit companies prior to administering necessary health services. The administration plans to pay these for-profit companies a portion of the “savings” collected from denied care. This is yet another example of the Trump administration prioritizing profits over patient care, and puts Medicare one step closer to Project 2025’s stated goal to make Medicare Advantage “the default enrollment option” nationwide and ultimately move the country toward a fully privatized, for-profit health system.
“We are concerned that this effort could erode the quality of coverage provided by Traditional Medicare and result in the delay and denial of necessary health care,” the lawmakers wrote. “Giving private for-profit actors a veto over care provided to seniors and people with disabilities in Traditional Medicare, even as a pilot program, opens the door to further erosion of our Medicare system. We therefore strongly urge you to immediately halt the proposed WISeR model and instead consider steps to address the well-documented waste, fraud, and abuse in the Medicare Advantage program.”
This new model from the Center for Medicare and Medicaid Innovation (CMMI), set to initiate on January 1, 2026, will require Traditional Medicare providers in New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington to obtain approval from for-profit companies prior to administering specific health services. This prior authorization process – a tool used by for-profit health insurers to reduce utilization of health care services they deem unnecessary – does nothing more than add administrative burden for providers and limit access to health care to increase corporate profits.
The lawmakers noted that an equally concerning aspect of this new model is CMMI’s solicitation of applications from companies, including Medicare Advantage plans, that use artificial intelligence (AI) to make medical necessity determinations. The use of AI in prior authorization likely increases denials of needed care and worsens the quality of care patients receive.
The full text of the letter can be found here.
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