Legislative Snapshot — January 2026: Skin‑Substitute Legislation & Related Medicare Actions

• Congress is considering multiple proposals to reform Medicare payment for skin substitute products. Proposed reforms include standardized payment rates, billing codes, and program‑integrity measures. 
• All bills discussed remain at the “Introduced” stage. 
• WISeR is already operational, affecting how some legislation would function if enacted. 

Multiple bills in the 119th Congress seek to reshape Medicare payment, coding, oversight, and access for skin‑substitute products and related advanced wound‑care therapies. This snapshot summarizes five relevant measures’ status as of January 26, 2026. 

Sponsor & status: Rep. Earl L. “Buddy” Carter (R-GA); introduced and referred to House Energy & Commerce and Ways & Means.  
Snapshot: H.R.5768 would amend Title XVIII to create a standardized Medicare payment system for skin substitute products, defining covered materials and setting 2026 payment as a volume-weighted average of existing limits. The bill proposes a single billing and payment code, payment at 80% of the lesser of charge or the new amount, and annual inflation adjustments thereafter. It also directs program-integrity actions — including identification of outlier providers and pre-payment review — aimed at curbing improper payments.¹

Sponsor & status: Sen. Bill Cassidy (R-LA); introduced and referred to Senate Finance Committee.  
Snapshot: S.2561 likewise seeks to revise Medicare payment rules for skin substitute products, stressing a payment framework that reflects clinical value while addressing rapidly rising Medicare spending on these therapies. The bill text establishes a baseline payment methodology and mechanisms to standardize reimbursement for qualifying products beginning in 2026. The measure frames its changes as a balance between preserving beneficiary access and restraining price escalation for advanced wound-care materials.²

Sponsor & status: Rep. Gabe Evans (R-CO); introduced and referred to committee(s) per Congress.gov.  
Snapshot: H.R.6852’s short title indicates a focus on payment and access issues for advanced wound care and regenerative products, and the bill page lists sponsor and referral data. The Congress.gov entry shows the bill is at the introduced stage; readers should consult the full text on the official page for precise statutory amendments proposed. Because the bill page on Congress.gov contains the official metadata but limited summary language, stakeholders should track committee activity for forthcoming analyses.³

Sponsor & status: Rep. Suzan K. DelBene (D-WA); introduced and referred to committees.  
Snapshot: H.R.5940 would prohibit implementation of the WISeR (Wasteful and Inappropriate Service Reduction) model under Medicare, blocking CMS from deploying that specific model as described in the bill text. Because CMS launched WISeR operations in six states effective January 1, 2026, the bill’s practical effect—if enacted—would be to rescind or prevent further rollout of the model despite its current implementation in pilot jurisdictions. Congress.gov lists the bill’s text and procedural status; the bill remains at the introduced stage pending committee action.⁴

Sponsor & status: (Congress.gov listing); introduced and listed as “Introduced.”  
Snapshot: H.R.6361 would constrain use of automated decisioning in Medicare denials/authorizations — a legislative approach related to concerns about AI-supported prior-authorization models such as WISeR. The bill page provides sponsor and referral metadata and is currently at the introduced stage on Congress.gov. Given CMS’s WISeR operational start (January 1, 2026), H.R.6361 and related measures would operate prospectively to limit or prohibit practices already deployed in the WISeR pilot states if enacted.⁵

1. H.R. 5768 — Skin Substitute Access and Payment Reform Act. 119th Cong. https://www.congress.gov/bill/119th-congress/house-bill/5768/text. Accessed January 26, 2026.  
2. S. 2561 — Skin Substitute Access and Payment Reform Act of 2025. 119th Cong. https://www.congress.gov/bill/119th-congress/senate-bill/2561/text. Accessed January 26, 2026.  
3. H.R. 6852 — Advanced Wound Care and Regenerative Medicine Access and Reform Act. 119th Cong. https://www.congress.gov/bill/119th-congress/house-bill/6852. Accessed January 26, 2026.  
4. H.R. 5940 — Seniors Deserve SMARTER Care Act of 2025. 119th Cong. https://www.congress.gov/bill/119th-congress/house-bill/5940/text. Accessed January 26, 2026.  
5. H.R. 6361 — Ban AI Denials in Medicare Act. 119th Cong. https://www.congress.gov/bill/119th-congress/house-bill/6361. Accessed January 26, 2026.  
6. Centers for Medicare & Medicaid Services. WISeR (Wasteful and Inappropriate Service Reduction) Model. CMS.gov. Accessed January 26, 2026.