Bill > HR6361

This bill prohibits the U.S. Department of Health and Human Services (HHS) from implementing two specific types of prior authorization models in Medicare. First, the bill specifically blocks the WISeR (Wasteful and Inappropriate Services Reduction) model, which was proposed in a federal notice published on July 1, 2025, that would have introduced a new prior authorization approach. Second, the bill amends the Social Security Act to prevent the Center for Medicare and Medicaid Innovation (CMI) from developing or testing any future payment models that involve prior authorization, including those that might use artificial intelligence (AI), for services covered under Medicare Part A or Part B. Prior authorization is a process where healthcare providers must obtain approval from an insurance provider before performing certain medical services or treatments. By prohibiting these models, the bill aims to limit potential restrictions on Medicare coverage and prevent the use of AI in determining healthcare service approvals. The legislation reflects concerns about potentially restrictive or algorithmic approaches to healthcare service authorization.

Budget and Finance

https://www.congress.gov/bill/119th-congress/house-bill/6361/all-info