Contributor ⭐

Medicare Prior Approval Pilot Program?

3 replies
1448 views

What is AARP's position on Medicare's soon to be enacted pilot program in six states that would require prior approval for certain medical procedures?

SereneSeagull

Community Champion ⭐⭐⭐

I believe if it’s what I read, AI driven for determining

C

CBtoo

Conversationalist ⭐⭐⭐

Yes that is correct and it is for 6 years. The list though of what will require prior authorization at this point in time is pretty short.

If you care to grit your teeth (as I know some of chose original medicare rather than an advantage plan because we didn't have to deal with referrals and prior authorizations for most things)

https://www.cms.gov/priorities/innovation/innovation-models/wiser

https://www.cms.gov/files/document/wiser-fact-sheet.pdf

Affected Services

The following 17 services will require prior authorization under the WISeR Model:

https://www.resourcemedicare.com/post/new-medicare-changes-in-2026-prior-approval-required-for-these-17-services

These are the states involved: Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington