A key legislative panel voted Tuesday to bar the Centers for Medicare & Medicaid Services from spending funds on a ...

CMS is launching a six-year pilot of the WISeR Model, starting January 2026 in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington, which will use AI and human review to expand prior ...

On June 27, 2025, the Centers for Medicare & Medicaid Services (“CMS”), through its Innovation Center (“CMMI”), released the Request for Applications (“RFA”) for a new payment and service delivery ...

The House Appropriations Committee made the amendment in a broader appropriations bill for the Department of Health and Human ...

In this second part of his interview with The American Journal of Managed Care®, Sanjay Doddamani, MD, MBA, a former senior advisor to CMMI and founder and CEO of Guidehealth, continues a dialogue on ...

The Centers for Medicare and Medicaid Services has announced a prior authorization program pilot for original Medicare. The six-year voluntary Wasteful and Inappropriate Service Reduction Model (WISeR ...

The Centers for Medicare & Medicaid Services (CMS) announced a new experimental model late last week to streamline some prior authorizations under the traditional Medicare program, but some ...

A 72-year-old in Phoenix needs a spinal cord stimulator for chronic back pain. Her surgeon orders the procedure. Before ...

Medicare is launching a new pilot program that will require prior approval for 17 health services using artificial intelligence tools. The Wasteful and Inappropriate Service Reduction (WISeR) model is ...

For now, the most reasonable stance is watchful waiting: acknowledging the real problems WISeR seeks to address, recognizing the equally real risks it introduces, and insisting on transparency and ...

We collaborate with the world's leading lawyers to deliver news tailored for you. Sign Up for any (or all) of our 25+ Newsletters. Some states have laws and ethical rules regarding solicitation and ...