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 House’s disapproval of the Center for Medicare and Medicaid Innovation’s proposed Wasteful and Inappropriate Services Reduction (WISeR) Model. The resolution claims the WISeR Model would expand prior authorization requirements in traditional Medicare by 30%, contract with private firms that already handle prior authorization for private insurers (including Medicare Advantage), and use advanced technologies such as artificial intelligence to manage these approvals. It argues that expanding prior authorization into traditional Medicare would hinder timely access to care and burden physicians, and it urges the Centers for Medicare and Medicaid Services (CMS) to terminate the WISeR Model. As a resolution, it does not itself create or change law but signals congressional opposition and can influence administrative policy discussions.
Key Points
- 1What WISeR proposes: A program to start January 1, 2026 that increases prior authorization requirements in traditional Medicare by 30% and involves private contractors currently handling prior authorizations for private plans, including Medicare Advantage; it would rely on enhanced technologies like AI/ML to process these decisions.
- 2Data and concerns cited: The bill references physician burnout linked to prior authorization (per AMA), historical issues with incorrect prior authorization decisions in private contractors (per CMS data and Kaiser Family Foundation), and reported high error rates for AI tools in reviewing coverage decisions (per Fierce Healthcare).
- 3Policy impact highlighted: The resolution argues that expanding MA-style prior authorizations into traditional Medicare would undermine timely access to necessary medical care for beneficiaries.
- 4Legislative stance: The House expresses disapproval of WISeR and strongly requests CMS terminate the model.
- 5Nature of the measure: This is a House resolution expressing a sense of the House, not a bill to enact or fund a program; it is a political and policy statement intended to influence administration decisions and public debate.