Congress blocks Medicare prior authorization experiment, trading cost control for faster access
H.R. 5940 — Seniors Deserve SMARTER Care Act of 2025 · Filed by Suzan DelBene (D-WA) · 47 cosponsors · Introduced Nov 7, 2025 · Referred to committee
Your members of Congress
Enter a ZIP to see where your representative and both senators stood on this bill.
Looked up on this device — your ZIP is never stored on our servers.
What it does
This bill prohibits the Department of Health and Human Services from implementing the WISeR model, a Medicare payment and service delivery system that would require prior authorization for select services. The bill blocks a specific regulatory initiative published in July 2025 that was designed to reduce wasteful and inappropriate services in Medicare.
Why we flagged it
The bill's operative mechanism is a straightforward prohibition on a specific Medicare payment model. It does not restructure Medicare, change beneficiary eligibility, or alter provider reimbursement rates—it simply blocks one regulatory initiative.
What the text implies
- Blocking WISeR prevents data collection on which services are most frequently denied or delayed under prior authorization, limiting future evidence on authorization's real-world impact on care quality and outcomes.
- The bill does not address whether Medicare will pursue alternative cost-control mechanisms, leaving potential for future regulatory attempts with different framing or structure.
The full analysis lists 3 implications of this text.
Who stands to gain
healthcare providers (reduced administrative burden from prior authorization); medical device and pharmaceutical suppliers (fewer authorization denials)