Bill Aims to Protect Medicare from AI-Driven Care Denials

The SMARTER Care Act seeks to stop WISeR model implementation from creating obstacles to homecare services

By Michelle Love

Legislation was introduced in the House of Representatives (HR 5940) and the Senate (S 3480) to halt a pilot program that would allow artificial intelligence (AI) and machine learning tools for prior authorization for some services in traditional Medicare across six states.

What is the SMARTER Care Act?

Both pieces of legislation, called the Seniors Deserve SMARTER (Streamlined Medical Approvals for Timely, Efficient Recovery) Care Act, would prohibit the Centers for Medicare & Medicaid Services (CMS) from implementing the Wasteful and Inappropriate Service Reduction (WISeR) model, which was set to begin Jan. 1, 2026, and run for six years.

The WISeR model received criticism shortly after CMS announced it. In August, 17 Democrat lawmakers wrote a letter to CMS Administrator Mehmet Oz arguing that the proposed prior authorization practices would prevent access to care and become a hindrance for those who need the care most.

“The Trump administration is gearing up to use AI to delay and deny Medicare benefits for seniors—this is outrageous and should be a national scandal,” said Sen. Patty Murray, vice chair of the Senate Appropriations Committee.

Sen. Kristen Gillibrand’s office said third-party AI companies involved in the program will be compensated based on a share of “averted expenditures”—rewarding companies based on the volume or cost of care they deny to seniors on Medicare. The administration has provided little detail on how patients will be notified,

supported or protected if prior authorization requests are denied.

Next Steps

The legislation has been referred to the House Committee on Ways and Means and to the House Committee on Energy and Commerce for a period to be determined by the speaker of the House. It has also been referred to the Senate Finance Committee.