Expressing the sense of the House of Representatives that the Wasteful and Inappropriate Service Reduction Model undermines beneficiary access to health care and should not be implemented.
H. Res. 704 is a non-binding resolution expressing the sense of the House of Representatives that the Wasteful and Inappropriate Service Reduction (WISeR) Model proposed by the Center for Medicare and Medicaid Innovation (CMMI) should not be implemented. The resolution argues that WISeR would expand prior authorization requirements in traditional Medicare by 30%, outsourcing these decisions to private contractors (including entities currently handling prior authorizations for private insurers and Medicare Advantage) and using advanced technologies like artificial intelligence and machine learning. It cites concerns that prior authorization itself creates barriers to needed care, and it highlights data from medical associations and analyses suggesting high rates of incorrect decisions and denials. The resolution states that expanding prior authorization into traditional Medicare would undermine beneficiary access to timely care and strongly urges the Centers for Medicare and Medicaid Services (CMS) to terminate the WISeR Model. This is a statement of opinion and does not itself change policy or authorize funding; it is a formal expression of opposition and a request to CMS.
Key Points
- 1WISeR Model scope and timeline: Proposed to begin January 1, 2026, and involve expanding prior authorization requirements in traditional Medicare by about 30%.
- 2Use of private contractors: WISeR would contract with private companies that already administer prior authorizations for private insurers, including Medicare Advantage plans.
- 3Role of technology: The model would employ enhanced technologies, including artificial intelligence and machine learning, to process the expanded prior authorizations in traditional Medicare.
- 4Cited concerns and evidence: The resolution cites prior authorization as an obstacle to care; it references physician burnout (AMA reporting 89% of physicians) and data showing high denial rates and overturns (e.g., 81.7% of denials overturned on appeal in some Medicare Advantage contexts; AI tools with high error rates in coverage decisions).
- 5House stance and requested action: The resolution disapproves of WISeR, finds that expanding prior authorization into traditional Medicare undermines access to timely care, and strongly requests CMS terminate the WISeR Model.