S.J. Res. 198 · On the floor · Health

A joint resolution 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".

Sponsor: Ron Wyden (D-OR)

What it does

• Nullifies the Centers for Medicare & Medicaid Services notice dated July 1, 2025, implementing the Medicare WISeR prior authorization model in six states (New Jersey, Ohio, Oklahoma, Texas, Arizona, Washington).
• Prohibits the Centers for Medicare & Medicaid Services from continuing to operate or test the prior authorization model that uses third-party contractors and artificial intelligence to determine Medicare claim coverage.
• Prevents contracting companies from being paid based on shares of savings generated through the prior authorization process.

Official summary

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…

Latest action

Jul 16, 2026: Motion to proceed to consideration of measure rejected in Senate by Yea-Nay Vote. 46 - 50. Record Vote Number: 199.

Committee: Senate Finance