Health Policy Affairs

On Sept. 22, SIR submitted a letter to the Center for Medicare and Medicaid Innovation (CMMI), an agency within the Centers for Medicare and Medicaid Services (CMS), that will launch the Wasteful and Inappropriate Service Reduction (WISeR) Model that uses technology-enabled prior authorization to identify and reduce waste, fraud, and abuse in original Medicare. This is set to take effect on Jan. 1, 2026, in six states (Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington) and will run through December 2031.

SIR has formally expressed strong opposition to the inclusion of prior authorization requirements for vertebral augmentation procedures in CMS's WISeR Model. This policy risks delaying or denying access to life-saving treatments for Medicare patients with vertebral compression fractures. Based on peer-reviewed evidence, these delays could result in dozens of avoidable deaths per 1,000 patients, a clinically indefensible outcome. SIR urges CMS to remove these requirements immediately and prioritize patient-centered, timely care.