Sponsors (44)
The bill preserves beneficiary access and reduces provider administrative burden by blocking new prior-authorization requirements, but at the cost of foregoing a potential tool to curb low-value care and program spending.
Medicare beneficiaries will keep existing access to the services targeted by the WISeR model without new prior-authorization barriers.
Hospitals and other providers avoid new administrative costs and delays that a prior-authorization program would have imposed.
Taxpayers and the Medicare program may lose a tool that could reduce wasteful or inappropriate services and associated spending.
Medicare beneficiaries could continue to be exposed to low-value care and potential health risks or overtreatment if the WISeR model would have cut unnecessary procedures.
Based on analysis of 2 sections of legislative text.
Bars HHS from implementing the WISeR Medicare prior-authorization model or any substantially similar model under Medicare.
Official title: To prohibit implementation of the WISeR model under the Medicare program.
Introduced November 7, 2025 by Suzan K. Delbene · Last progress November 7, 2025
Prohibits the HHS Secretary from implementing the WISeR model or any substantially similar prior-authorization model under Medicare. The bill bars use of the specific program described in the July 1, 2025 Federal Register notice and stops the agency from putting a similar Medicare prior-authorization approach into effect. The effect is to block Medicare from adopting this named model for selecting or requiring prior authorization for services identified as “wasteful and inappropriate,” which would affect beneficiaries, providers, and Medicare program policy on utilization management.