Medicare Prior Approval Pilot Program?

[LaurieM808259]

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]

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

[CBtoo]

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...

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

[KenD491217]

Thanks for posting this. I'm very troubled by this proposal and also would like know AARP's position.