The House Appropriations Committee is seeking to cut funding for the Wasteful and Inappropriate Services Reduction Model, a pilot program introduced by the Centers for Medicare & Medicaid Services last year.
The committee amended the Labor, Health and Human Services, Education and Related Agencies appropriations bill to prevent the use of funds for the model, which aims to introduce prior authorization in Medicare.
According to the Manager’s Amendment, “None of the funds made available in this Act or any other Act may be used to implement CMS-5056-N, ‘Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction Model,’ or any such model that implements prior authorizations in traditional Medicare.”
The model has been controversial since its announcement in June 2025, with the pilot scheduled to begin this year in six states: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington.
House Democrats introduced legislation to get rid of the model late last year, citing concerns over the use of artificial intelligence to automate prior authorization and the payment structure for participating vendors.
The American Hospital Association voiced concerns in a letter to CMS.
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The vendors would be compensated based on a share of “averted expenditures,” rewarding participants based on the volume or cost of care they deny, the representatives said in a press release.
Looking at the Centers for Medicare & Medicaid Services for more information on the model and its potential impact on healthcare is worthwhile.
The House Appropriations Committee’s amendment is a significant development in the ongoing debate about the model and its potential impact on the healthcare industry, and the committee will continue to review the bill and make adjustments as necessary.
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