House panel blocks funding for traditional Medicare prior authorization pilot 

The House Appropriations Committee has advanced a spending bill for 2026 that includes an amendment blocking funding for a pilot program that would add prior authorization for some traditional fee-for-service. 

CMS unveiled the Wasteful and Inappropriate Service Reduction initiative in June, with six states selected for the pilot slated to begin in January. Under the model, CMS will partner with companies specializing in AI and machine learning to test ways to provide an improved and expedited prior authorization process for certain Medicare services. Companies hired to manage the initiative will be paid based on how much money they save the federal government by stopping payment for unnecessary or noncovered services.

Rep. Lois Frankel introduced the amendment to block funding for the pilot program during a Sept. 9 Appropriations Committee meeting. 

She said during the hearing that the program would create “new roadblocks for seniors who depend on Medicare coverage.” 

“Let’s not bring this nightmare to Medicare, the one program that seniors still count on for guaranteed straightforward care,” she said. 

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