Sponsors (43)
The bill preserves beneficiary access and avoids new administrative burdens from prior authorization, but forgoes a policy tool that could reduce wasteful care and federal Medicare spending, potentially leaving beneficiaries exposed to unnecessary procedures.
Medicare beneficiaries keep current access to services targeted by the WISeR model without new prior-authorization requirements, avoiding added delays or denials of care.
Hospitals and healthcare providers avoid new administrative burdens, costs, and treatment delays that a WISeR-based prior-authorization program would impose.
Taxpayers and the Medicare program lose a tool intended to reduce wasteful or inappropriate services, which could raise federal spending and program costs.
Medicare beneficiaries may continue to receive low-value or unnecessary procedures, increasing exposure to potential health risks, overtreatment, and avoidable harms.
Based on analysis of 2 sections of legislative text.
Bars HHS from implementing the WISeR prior-authorization model or any substantially similar model in the Medicare program.
Introduced November 7, 2025 by Suzan K. Delbene · Last progress November 7, 2025
Prohibits the Department of Health and Human Services from putting into effect the WISeR prior-authorization model (the “Wasteful and Inappropriate Services Reduction” model) described in the Federal Register notice at 90 Fed. Reg. 28749 (July 1, 2025), or any substantially similar model for the Medicare program. It also gives the act a short title for citation. In practice, the law would stop Medicare from rolling out a specific prior-authorization approach intended to reduce certain services deemed wasteful or inappropriate, preserving current prior-authorization rules and preventing adoption of that model or ones that look substantially the same.