Congressional Scrutiny Intensifies Over CMS’ WISeR Model and Prior Authorization in Traditional Medicare
August 12, 2025
The Centers for Medicare & Medicaid Services’ (CMS) WISeR model (originally designed to streamline utilization management and prior authorization processes) is facing renewed attention from lawmakers. A bipartisan congressional letter sent to CMS questions the agency’s legal authority to apply the model to traditional Medicare and warns of potential impacts on beneficiary access, provider operations, and program compliance. As the healthcare industry awaits CMS’ response, payer and provider organizations should prepare for possible policy adjustments that could affect authorization workflows, clinical operations, and financial performance.
