CMMI Launches Voluntary Model Introducing Prior Authorization in Medicare Fee-for-Service
The Center for Medicare and Medicaid Innovation (CMMI) recently announced the Wasteful and Inappropriate Service Reduction (WiSeR) Model, a voluntary initiative that marks a significant shift from traditional Medicare fee-for-service. The model allows technology companies to implement prior authorization for select Medicare fee-for-service items and services using advanced technologies like artificial intelligence and machine learning. Providers and suppliers in participating regions can either submit a prior authorization request before delivering services or undergo a post-service/pre-payment review. Applications are open through July 25, with the model running from January 2026 to December 2031.
Health Plans Pledge Prior Authorization Reform, but SNFs Seek Clarity
Major health insurers in recent weeks pledged to streamline and simplify prior authorization across Medicare Advantage, Medicaid managed care, the Marketplace, and commercial plans. These commitments take steps toward meeting federal requirements and propose reforms aimed at reducing delays and easing provider burden. The impact on skilled nursing facilities (SNFs) and post-acute care (PAC) providers remains unclear. AHCA/NCAL calls for greater clarity and meaningful inclusion of SNFs and PAC providers to ensure reforms are responsive to the unique needs of these providers and patients.