February 2026 Legislative Snapshot: Bills Targeting Medicare Skin Substitute Payment and Prior Authorization Policy

A series of bills introduced in the 119th Congress would make significant changes to Medicare payment policy for skin substitute products and to the agency’s authority to test certain prior authorization models. While all measures currently remain at the introduced stage, the proposals signal continued congressional focus on reimbursement methodology, utilization oversight, and the role of technology in Medicare coverage administration. 

Key Takeaways 

• Multiple bipartisan bills in the 119th Congress would restructure how Medicare pays for skin substitute products under Part B, including proposals to establish a standardized national payment methodology and consolidated billing code. 
• Several measures seek to address perceived payment distortions and utilization trends through updated reimbursement formulas and enhanced program integrity mechanisms. 
• One House bill would combine payment reform with site-of-care payment alignment and targeted oversight of high-volume providers. 
• Separate legislation would prohibit or limit Medicare’s ability to implement or test certain prior authorization models, including those that incorporate artificial intelligence tools. 

H.R. 5768 — Skin Substitute Access and Payment Reform Act 

Sponsor: Rep. Earl L. “Buddy” Carter (R–GA)  
Current status (Congress.gov): Introduced  
Snapshot¹: The bill would amend Title XVIII of the Social Security Act to address Medicare coverage and payment for “skin substitute products.” (Congress.gov) It would add skin substitute products to the statutory list of covered medical and other health services and apply Section 1847A payment rules to skin substitute products furnished on or after January 1, 2026. For 2026, the payment amount would be set using a volume-weighted average of Medicare payment allowance limits using October 2023 ASP Pricing File limits and 2023 Part B claims units in CMS’s Integrated Data Repository; for 2027 and later, the amount would be updated annually by CPI-U. The bill also defines “skin substitute product,” including exclusions (eg, dressings and certain non-solid forms such as liquids or gels).  

S. 2561 — Skin Substitute Access and Payment Reform Act of 2025 

Sponsor: Sen. Bill Cassidy (R–LA)  
Current status (Congress.gov): Introduced  
Snapshot²: The Senate bill states congressional findings regarding Medicare payment incentives and spending trends for skin substitute products and then proposes a payment reform beginning January 1, 2026. It would add a new paragraph under Section 1847A(b) setting the payment amount for skin substitute products as a volume-weighted average derived from published payment allowance limits in the fourth calendar quarter of 2023 ASP Pricing File and Part B claims volume (Oct. 1–Dec. 31, 2023) in the Integrated Data Repository. The bill defines “skin substitute product,” directs the Secretary to establish a new billing and payment code for all skin substitute products by January 1, 2026, and specifies additional rules on coverage criteria and certain reporting requirements.  

H.R. 6852 — Advanced Wound Care and Regenerative Medicine Access and Reform Act 

Sponsor: Rep. Gabe Evans (R–CO)  
Current status (Congress.gov): Introduced  
Snapshot³: The bill would apply a Medicare payment approach for skin substitute products furnished on or after January 1, 2026, using a volume-weighted average framework and CPI-U updates in subsequent years. (Congress.gov) It directs the Secretary to establish a single billing and payment code for all skin substitute products by January 1, 2026. (Congress.gov) The bill also directs the Secretary to ensure reimbursement for skin substitute products and outpatient applications is equivalent regardless of outpatient site of care, referencing the Section 1847A(b)(9) amounts. (Congress.gov) In addition, it adds a set of program integrity provisions, including identifying the top 3% of providers by total Medicare payment for skin substitute products as “outlier providers,” public posting and referral to the HHS Inspector General, prepayment review starting March 1, 2026 (with specified limitations), and a pathway to apply prior authorization for outlier providers beginning no later than January 1, 2027. (Congress.gov) 

H.R. 5940 — Seniors Deserve SMARTER Care Act of 2025 

Sponsor: Rep. Suzan K. DelBene (D–WA)  
Current status (Congress.gov): Introduced  
Snapshot⁴: This bill would prohibit the Secretary of Health and Human Services from implementing the “innovative payment and service delivery model” described in a Federal Register notice titled, “Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model” (90 Fed. Reg. 28749, July 1, 2025), or any “substantially similar model.” The operative provision is a single prohibition on implementation. 

H.R. 6361 — Ban AI Denials in Medicare Act 

Sponsor: Rep. Greg Landsman (D–OH)  
Current status (Congress.gov): Introduced  
Snapshot⁵: The bill would prohibit implementation of the WISeR model described in the same July 1, 2025 Federal Register notice (and any substantially similar model). It would also amend Section 1115A(b)(2) of the Social Security Act to add a limitation: beginning on enactment, the Secretary may not select a model to be tested if it would implement prior authorization (including through AI) for items or services payable under Medicare Part A or Part B.  
 
References  
1. H.R. 5768 — Skin Substitute Access and Payment Reform Act. 119th Cong. Accessed March 2, 2026. https://www.congress.gov/bill/119th-congress/house-bill/5768/text  
2. S. 2561 — Skin Substitute Access and Payment Reform Act of 2025. 119th Cong. Accessed March 2, 2026. https://www.congress.gov/bill/119th-congress/senate-bill/2561/text  
3. H.R. 6852 — Advanced Wound Care and Regenerative Medicine Access and Reform Act. 119th Cong. Accessed March 2, 2026. https://www.congress.gov/bill/119th-congress/house-bill/6852  
4. H.R. 5940 — Seniors Deserve SMARTER Care Act of 2025. 119th Cong. Accessed January 26, 2026. https://www.congress.gov/bill/119th-congress/house-bill/5940/text  
5. H.R. 6361 — Ban AI Denials in Medicare Act. 119th Cong. Accessed January 26, 2026. https://www.congress.gov/bill/119th-congress/house-bill/6361