Health Original Medicare now requires prior approval for some procedures in a handful of states By Tyler Foster, For decades, one of the clearest advantages of traditional Medicare over private Medicare Advantage plans was the absence of prior authorization. A patient in Original Medicare could see any participating doctor and schedule a covered procedure without waiting for an insurer to sign off first. That distinction is narrowing. Under a federal test now underway, Original Medicare requires advance approval for a defined list of procedures in six states, marking the first time in years that the government’s own program has imposed the kind of gatekeeping long associated with private plans. The WISeR model and the six test states The change comes through the Wasteful and Inappropriate Service Reduction model, a payment experiment run by the federal innovation office that designs and tests new ways of paying for care. Rather than apply nationwide, the model operates in a limited set of jurisdictions selected to test whether advance review reduces spending on services the agency considers prone to overuse. It is a pilot with a fixed lifespan, not a permanent rewrite of Original Medicare, and its results are meant to inform whether the approach spreads. The model is one of several run by the Center for Medicare and Medicaid Innovation, which holds statutory authority to try alternative payment designs on a limited basis before any decision to expand them. That authority is why the requirement can appear in some states and not others without an act of Congress, and it is also why the arrangement carries an expiration date rather than standing as a permanent feature of the program.