Congress Moves to Block Medicare’s WISeR Model, Protecting Seniors from New Prior Authorization Rules

If you’ve ever dealt with Medicare, you know the drill: paperwork, approvals, and sometimes maddening delays. This is why the Seniors Deserve SMARTER Care Act of 2025 is such a focused piece of legislation. It does one thing and one thing only: it tells the Secretary of Health and Human Services (HHS) to stop the implementation of the Wasteful and Inappropriate Services Reduction (WISeR) Model under Medicare.

This isn't about creating a new program; it’s about torpedoing an existing plan before it launches. The bill specifically bans the WISeR model, which was detailed in a Federal Register notice (90 Fed. Reg. 28749), or anything that looks “substantially similar.” Essentially, Congress is putting up a roadblock to prevent a new layer of bureaucracy from hitting seniors and their doctors. Given the bill’s title—SMARTER Care—it’s clear the intent is to protect timely access to medical services.

The Prior Authorization Problem

While the bill doesn't spell out the specifics of the WISeR model, its name and context strongly suggest it involves expanding prior authorization for select services. For busy people, prior authorization is the administrative hurdle where your doctor has to ask permission from the insurance company (or Medicare, in this case) before you can get a test, procedure, or drug. Think of it like needing a manager’s signature just to buy office supplies—it slows everything down.

For a senior needing a specific diagnostic scan or procedure, a new prior authorization requirement could mean the difference between getting care this week or next month. This delay can be particularly critical for older patients. By blocking WISeR, this bill aims to prevent those potential delays and administrative headaches from ever landing on the desks of doctors and the laps of Medicare beneficiaries. It’s a win for efficiency and timely care, ensuring seniors aren't caught in a new web of paperwork.

Who Wins and Who Loses?

On the winning side are Medicare beneficiaries (seniors) and the healthcare providers who serve them. Doctors and hospitals already spend countless hours battling insurance companies over prior authorization; blocking the WISeR model saves them from a new administrative burden, freeing up time that can be better spent with patients. For seniors, it means fewer hoops to jump through when they need care most.

However, there is a flip side. The WISeR model was likely developed by the Centers for Medicare & Medicaid Innovation (CMMI) with the goal of reducing actual waste and inappropriate services—hence its name. By blocking this model, the bill potentially allows some level of inefficient spending to continue. The people who lose here are the HHS officials and CMMI staff who were tasked with finding ways to rein in costs. The policy trade-off here is clear: prioritizing timely access over a specific, proposed cost-saving measure. This bill says, loud and clear, that the potential administrative burden of WISeR isn't worth the potential savings, at least not in its current form.