We at WSHA would like to extend sincere thanks to U.S. Representatives Susan DelBene, Marilyn Strickland and Emily Randall for their strong letter to CMS Administrator Memet Oz, raising urgent concerns about the WISeR model and its expansion of prior authorization in Traditional Medicare.
The WISeR model introduces new pre-approval requirements that rely on artificial intelligence and private contractors. These changes risk delaying care, increasing administrative burden and undermining the trust patients place in their providers. Washington patients and providers will be directly affected, as clinical decisions may be replaced by algorithms that prioritize cost savings over patient outcomes.
WSHA shares the concerns outlined in the letter. Prior authorization, when misused, can lead to harmful delays, increased provider burnout and denials of care that are often overturned on appeal. People covered by Medicare expect their care to be guided by their doctors, not by insurance companies or automated systems.
The questions raised in the letter are critical: How will reviewers be qualified? How will patients be informed of their rights? What safeguards will prevent profit-driven denials of care? These issues demand clear answers before any expansion of prior authorization is implemented.
WSHA will continue to support policies that promote timely, high-quality care and reduce administrative barriers that interfere with the patient-provider relationship. We are grateful for the leadership shown by Representatives DelBene, Strickland, and Randall in standing up for Washington’s seniors and health care professionals.
Sincerely
Jacqueline Barton True
WSHA Vice President, Advocacy and Rural Health
jacquelineb@wsha.org