Dec. 19, 2025
End-of-Year Update: WSMA Advocacy on WISeR Program
Washington state is among six states selected for a new federal prior authorization pilot program scheduled to begin Jan. 1, 2026 for enrollees of traditional Medicare. Known as the Wasteful and Inappropriate Service Reduction Model, the program was developed by the Centers for Medicare and Medicaid Services and will apply prior authorization requirements to selected services, with artificial intelligence playing a major role in utilization management.
Over the past year, the WSMA has engaged extensively to raise serious concerns about the WISeR Model and its potential impact on Washington physicians and Medicare patients.
WSMA advocacy and congressional engagement
The WSMA has communicated numerous significant concerns about the WISeR Model to Washington state's congressional delegation, CMS Regional Office X, and other federal policymakers. In addition, the WSMA led a coalition of impacted state medical associations in a joint letter to CMS Administrator Dr. Mehmet Oz outlining shared concerns, including:
- Increased administrative burden on physician practices.
- New barriers to timely, appropriate care for traditional Medicare patients.
- A vendor incentive structure that could encourage excessive denials driven more by profit motives than by fair, clinically grounded decision-making.
The WSMA emphasized that introducing AI-enabled utilization management into traditional Medicare represents a fundamental shift with far-reaching implications, and that CMS has not adequately demonstrated patient protections, transparency, or accountability safeguards.
Legislative efforts to repeal the WISeR Model
At the request of Sen. Patty Murray and Rep. Suzan DelBene, the WSMA formally endorsed both the Senate and House versions of the Seniors Deserve SMARTER (Streamlined Medical Approvals for Timely, Efficient Recovery) Care Act, legislation that would repeal the WISeR Model in its entirety.
In support of the Senate version, Bridget Bush, MD, FASA, shared the following statement:
"The Washington State Medical Association applauds Senator Murray for introducing the Seniors Deserve SMARTER Care Act - a necessary step toward protecting patients from burdensome prior authorization policies. The proposed legislation recognizes what physicians and patients have long warned about: the Centers for Medicare and Medicaid Services' WISeR pilot would impose unnecessary delays, expand administrative waste, and ultimately jeopardize patient access to care. We stand firmly with Senator Murray in calling for a complete prohibition on implementation of the WISeR Model and urge lawmakers to enact the SMARTER Care Act swiftly to ensure timely, patient-centered care remains the priority."
Media coverage and public awareness
Advocacy on the part of WSMA's physician leadership and staff has helped elevate concerns about the WISeR Model in both state and national media:
Looking ahead: Monitoring implementation requires physician feedback
Despite sustained advocacy efforts from the WSMA and other medical associations at the federal level, CMS has not indicated an intention to abandon or delay implementation of the WISeR Model. As a result, WSMA's focus will now expand to supporting impacted physician groups as they prepare for and navigate the program.
At the same time, WSMA's advocacy does not end here. Physician experience under WISeR will be critical to informing ongoing congressional oversight and future CMS decision-making. The WSMA is uniquely positioned to serve as a conduit between Washington physicians, members of Congress, and CMS.
We strongly encourage physician groups subject to WISeR to share their experiences, including administrative challenges, access issues, and any observed impacts on patient care-positive or negative. This feedback will be essential as the WSMA continues to press for accountability and reform.
To share your experience or concerns, contact WSMA Director of Policy Jeb Shepard at jeb@wsma.org.