Daily Intelligence Briefing: Three New Gates Went Live (Medicare, Payment Apps, Rentals)

We translate the language, name the mechanism, and give you the counter-move.

Why this matters today

Three systems have just raised the burden of proof on households, and the changes are already in effect. One can delay care for seniors. One can create tax-season confusion for anyone using payment apps. One is a policy signal that targets the credit-score gate in rental housing.

This briefing does one job: translate the official language into household consequences, then give you a 15-minute counter-move you can actually complete.

Who should read what first

• In AZ, NJ, OH, OK, TX, WA, and you have a procedure scheduled: start with Signal 1.

• You sell anything online or take payments through apps: start with Signal 2.

• You are renting, moving, or helping someone apply for housing: start with Signal 3.

Big week ahead
Paid subscribers get today’s full brief plus this week’s Weekly Case Study and the Monthly Patterns Analysis. If these briefings save you time, money, or a denial spiral even once, the paid tier is designed to pay for itself.

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Signal 1: Original Medicare adds prior authorization in 6 states

What happened:
Starting January 1, 2026, specific Original Medicare claims in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington face a new “approve it first” rule under the Wasteful and Inappropriate Service Reduction (WISeR) Model. That rule requires prior authorization for a defined list of procedures. GovInfo

Code words used:
“Prior authorization,” “model participant state,” “medical necessity,” “selected services,” “coverage determination,” “Medicare Administrative Contractor.”

In plain English:
If you live in one of the six states and need one of the procedures below, your clinician may have to get approval before the service happens (or before billing). If the paperwork is late, incomplete, or denied, the claim can be delayed or denied and the dispute becomes your problem.

The 17 procedures (the list):

1. Electrical nerve stimulators

2. Sacral nerve stimulation for urinary incontinence

3. Phrenic nerve stimulator

4. Deep brain stimulation for essential tremor and Parkinson’s disease

5. Vagus nerve stimulation

6. Induced lesions of nerve tracts

7. Epidural steroid injections for pain management (excluding facet joint injections)

8. Percutaneous vertebral augmentation for vertebral compression fracture

9. Cervical fusion

10. Arthroscopic lavage and arthroscopic debridement for osteoarthritic knee

11. Hypoglossal nerve stimulation for obstructive sleep apnea

12. Incontinence control devices

13. Diagnosis and treatment of impotence

14. Percutaneous image-guided lumbar decompression for spinal stenosis

15. Skin and tissue substitutes (category)

16. Application of bioengineered skin substitutes to lower extremity chronic non-healing wounds

17. Wound application of cellular and or tissue-based products to lower extremities

Extraction mechanism:
Scope: Original Medicare households in 6 states are facing added authorization steps for specific procedures.
Mechanism: A new approval layer (forms, documentation, timetables) that can delay access, shift the burden to patients, and convert care into an administrative endurance test.

The toll:
Delays: appointments get pushed while approvals pend.
Paperwork: extra forms, extra “medical necessity” narratives, extra resubmissions.
Risk transfer: if it is denied, the household is pressured to fight, appeal, or abandon care.

What to watch next (30 to 90 days):
Provider offices in the six states will start building new workflows, and some will quietly steer patients away from specific procedures if approval is slow or denial rates rise. Watch for sudden rescheduling patterns and for “we’re waiting on approval” language becoming the norm.

Reader counter-move:
Set a phone timer for 15 minutes. Do the first step now.

1. If you have any procedure scheduled that resembles the list above, call the ordering clinician’s office and ask: “Are you submitting prior authorization for this procedure under the new Medicare rules in our state?”

2. Ask for the submission date, the tracking number, and who is responsible for follow-up. Write it down.

3. Ask the office to send you a short confirmation in your portal message thread that includes: procedure name, planned date, and “prior authorization submitted.”

4. If the procedure is within 14 days, ask what their escalation path is if approval does not arrive.

If stuck, say this:
“I’m in a WISeR state. Please confirm in writing whether prior authorization is required for my procedure, whether it has been submitted, and the tracking number and expected decision date.”

SOURCES:

• Federal Register notice establishing WISeR model parameters, states, effective date, and selected services list. GovInfo

• CMS WISeR model overview page (program description and implementation framing). CMS

Teaser for Signal 2: A primary reporting rule for payment apps just snapped back to the old threshold, and the “no form means no tax” assumption is about to hurt people.

Teaser for Signal 3: A House bill would block landlords from using credit checks to make adverse rental decisions, even if a tenant “consents.”

• Paid subscribers get the full procedure list, the script to use with your doctor’s office, and the escalation steps.”

• Plus this week: the Weekly Case Study and Monthly Patterns Analysis across healthcare, voting, utilities, and consumer protection.