Sponsors (46)
The bill preserves beneficiary access and reduces provider administrative burden by blocking WISeR prior-authorization measures, but it forgoes a tool that could curb wasteful care and federal Medicare spending, potentially leaving beneficiaries exposed to low-value services.
Medicare beneficiaries: retain current access to the services targeted by the WISeR model without new prior-authorization barriers, preventing potential delays or denials of care.
Hospitals and providers: avoid added administrative costs and delays because the bill prevents implementing a new prior-authorization program under WISeR, reducing provider burden and workflow disruption.
Taxpayers and the Medicare program: lose a utilization-management tool that could reduce wasteful or inappropriate services and associated spending, potentially increasing federal health expenditures.
Medicare beneficiaries: may continue to face exposure to low-value or unnecessary procedures, risking overtreatment and possible health harms if the WISeR model would have curtailed such care.
Based on analysis of 2 sections of legislative text.
Blocks HHS from implementing the WISeR 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 Department of Health and Human Services from implementing the WISeR model (Wasteful and Inappropriate Services Reduction) or any substantially similar prior-authorization model under the Medicare program. The bill stops HHS from rolling out the specific prior authorization approach described in the Federal Register notice at 90 Fed. Reg. 28749 (July 1, 2025).