In late June, the Centers for Medicaid and Medicare Innovation released plans to include Washington State in a six-state, six-year pilot project, aimed at curbing Medicare spending and incidents of fraud. The other states include New Jersey, Oklahoma, Ohio, Texas, and Arizona.
Known as the Wasteful and Inappropriate Service Reduction (WISeR) program, the WISeR pilot will expand pre-authorization requirements to traditional Medicare, which is currently limited to very few provider-recommended procedures. This pre-authorization model is commonplace with privatized Medicare Advantage plans that have well-documented high denial rates for medically necessary procedures.
The pilot conflicts with two long-standing federal healthcare priorities…
