CMS official says parts of the WISeR AI prior auth test are not working
A CMS deputy administrator says Medicare's AI prior authorization test has problems.
“There are a lot of things about WISeR that are not working,” Kimberly Brandt said Oct 15 at the ADAPT conference in Santa Fe, Nextgov/FCW reported. She did not say which parts.
WISeR started Jan 1, 2026 and runs through 2031 in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. Six technology companies review requests for services such as skin substitutes, nerve stimulator implants and knee arthroscopy. They are paid a share of the spending their reviews avert. It covers Original Medicare only, not Medicare Advantage. Another Original Medicare change, the proposed CMS 2027 remote patient monitoring rule, is due in final form by Nov. 1.
Her slides listed the lessons so far. The technology needs continuous oversight, human clinical review is essential, and provider feedback is a warning signal.
The House Ways and Means Committee advanced a provision in June to end WISeR. The Senate has rejected efforts to stop it.
Why it matters
CMS has not published an evaluation, so for now a deputy administrator’s own words are the clearest public signal of how the pilot is going.
FDA
