On June 27, 2025, the Centers for Medicare & Medicaid Services (CMS) announced the launch of a new CMS Innovation Center model for Medicare, called the Wasteful and Inappropriate Service Reduction (WISeR) Model. Medicare is a federal insurance program that provides healthcare coverage primarily for patients aged 65 and older. Original Medicare, also called traditional Medicare, refers to Medicare Part A (hospital insurance), which covers hospital and inpatient stays and Medicare Part B (medical insurance), which covers outpatient services, like doctor visits and some preventative health screenings and vaccines. There is also Medicare Part D (prescription drug coverage), which helps cover the costs of prescription medications. An alternative option to traditional Medicare is also available to eligible patients who can enroll in plans called Medicare Advantage Plans (also known as Medicare Part C). Medicare Advantage Plans are Medicare-approved plans offered by a private health insurance company that typically cover Medicare Parts A, B, and D.
The CMS Innovation Center was established in 2010 as part of the Affordable Care Act (ACA). The goal of the CMS Innovation Center is to develop new healthcare service and payment models (also called alternative payment models, or APMs) that can be implemented to help improve patient health care while also lowering healthcare costs. These models are designed with a goal of improving efficiency, minimizing waste and maintaining a high level of value-based care to promote positive health outcomes and maximize clinical benefits among those receiving care. The WISeR model will be tested in select states, including New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington, starting on January 1, 2026. As part of the model, prior authorization will be needed for 17 selected services identified by CMS as vulnerable to fraud, waste, abuse or inappropriate use. Prior authorization means that providers must get approval from Medicare prior to administering the requested service to the patient.