Senate Democrats don’t like it all, and a technology expert in the long-term care space objects for reasons of his own. What we are talking about is the WISeR pilot program that the Centers for Medicare and Medicaid Services (CMS) is experimenting with to allow AI to conduct prior authorization determinations for certain seniors’ medical claims in Traditional Medicare.

First, the lawmakers. This week, Senate Finance Committee Ranking Member Ron Wyden (D-Ore.) and Sens. Patty Murray (D-Wash.), Maria Cantwell (D-Wash.), Richard Blumenthal (D-Ct.), and Kirsten Gillibrand (D-N.Y.) led 20 Senate Democrats in introducing a resolution to invoke the Congressional Review Act (CRA) and end the WISeR pilot.

"Americans are sick and tired of abusive prior authorization tactics putting needed healthcare out of reach," Wyden said. "The last thing seniors need is even more AI denying the care they need."

Last year, CMS launched the pilot to approve or deny select medical services for Medicare beneficiaries in six states. Since then, a group of Senate Democrats has sought to end the program. And just last their efforts got a boost when the Government Accountability Office released a determination said the WISeR model is subject to the CRA. This determination starts a 60-day period during which Democrats can force a vote on the resolution of disapproval to repeal the WISeR model.

Clearing Up the Debate

Mordy Eisenberg, co-founder/chief growth officer, TapestryHealth, wanted to clear up what the WISeR debate is about, and what it is not. He said resistance to AI in prior authorization is fundamentally different from the usual tech skepticism in post-acute care. “When we talk about adopting EHRs or digital care coordination tools, the friction is about workflow disruption, training curves, and upfront costs—but providers ultimately see themselves retaining clinical decision-making authority,” Eisenberg said.

“With AI-driven prior authorization, we're crossing into different territory entirely. This isn't about whether technology makes the job easier, it's about who makes the clinical call. When an algorithm becomes the gatekeeper between a physician's recommendation and patient access to care, you're introducing a fundamental power shift that providers rightfully view as an erosion of clinical autonomy,” he said.

Eisenberg said the pushback isn't just "this is new and scary"—it's "this removes human judgment from decisions that require human judgment."

WISeR on the Wrong Frequency

He stressed that the CMS pilot is asking the wrong question. The premise of WISeR is essentially "can AI help us deny more care to save money?" This frames the entire exercise as cost containment through restriction rather than clinical appropriateness. That's a dangerous starting point, Eisenberg said.

The real issue isn't whether AI can make prior authorization decisions, it's whether it should. “Prior authorization is already one of the most despised administrative barriers in healthcare, causing treatment delays and creating massive documentation burdens. Layering AI onto a broken process doesn't fix the process; it just automates denial at scale,” he said.

“If CMS wanted to test AI in a meaningful way, they'd pilot it to eliminate prior auth friction—using AI to fast-track approvals for clinically appropriate cases, not to add another denial layer. Instead, WISeR targets services with ‘higher risk of waste, fraud, and abuse’ but applies a blanket algorithmic screening that can't account for individual patient complexity. That's not precision medicine—that's just rationing with extra steps,” Eisenberg said.

Lastly, the pilot’s six-year timeline with minimal transparency about how these algorithms make decisions is equally concerning, he added. “In an industry already struggling with care access and provider burnout, we're beta-testing black-box denials on 6.4 million Medicare beneficiaries. That's not a pilot—that's a policy experiment being run at patient expense.”

The summary of the Democrat’s resolution is here. A House companion resolution was introduced by Representatives Greg Landsman (D-Ohio) and Suzan DelBene (D-Wash.).

The CMS summary of the WISeR model is here.

Questions or comments? Contact Patrick Connole at pconnole@parkplacelive.com.