Industry Watch Alert
Summary
- House members introduce the Seniors Deserve SMARTER Care Act to halt CMS’s WISeR Model, a six-year prior authorization pilot in six states. The bill reflects ongoing debate about the use of artificial intelligence and vendor-based review in Medicare.
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Background
The Seniors Deserve SMARTER Care Act of 2025 was introduced on November 7, 2025 by Representatives Rick Larsen (WA-02), Suzan DelBene (WA-01), Kim Schrier (WA-08), Greg Landsman (OH-01), Ami Bera (CA-06), and Mark Pocan (WI-02).
The bill would prohibit the Secretary of Health and Human Services from carrying out the WISeR Model or any substantially similar model within Medicare fee-for-service.
The WISeR Model, announced by CMS in July 2025, is a technology-enabled pilot designed to apply prior authorization or pre-payment review to selected services considered at risk for fraud, waste, or misuse. The model will be tested in New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington from 2026 to 2031.
Congressional Intent
According to the sponsors, the legislation responds to concerns that the WISeR Model would introduce new layers of prior authorization into Original Medicare and delegate medical review functions to private vendors using artificial intelligence tools.
Stakeholder Response
The American Hospital Association (AHA) submitted comments to CMS on October 23, 2025, identifying issues related to vendor payment incentives, algorithm transparency, provider burden, and the short implementation timeline. The AHA recommended that CMS delay implementation by at least six months to allow for additional evaluation and stakeholder input.
Next Steps
The bill has been referred to the House Committee on Energy and Commerce for further consideration. CMS has not announced any change to the WISeR implementation timeline pending legislative review.
Sources
U.S. House of Representatives. Seniors Deserve SMARTER Care Act of 2025 (DelBene 023 XML WISeR). Introduced November 7 2025. Retrieved from https://delbene.house.gov/uploadedfiles/delben_023_xml_wiser.pdf
Office of Representative Rick Larsen. Larsen, DelBene, Colleagues Introduce Legislation to Protect Seniors’ Access to Care. News release, November 7 2025. Retrieved from https://larsen.house.gov/news/documentsingle.aspx?DocumentID=4046
American Hospital Association (AHA). Letter to CMS on the Wasteful and Inappropriate Services Reduction (WISeR) Model. October 23 2025. Retrieved from https://www.aha.org/lettercomment/2025-10-23-aha-comments-cms-wiser-model
Centers for Medicare & Medicaid Services. Wasteful and Inappropriate Service Reduction (WISeR) Model – Frequently Asked Questions. Retrieved September 2025 from https://www.cms.gov/priorities/innovation/files/document/wiser-model-frequently-asked-questions
Centers for Medicare & Medicaid Services. Wasteful and Inappropriate Service Reduction (WISeR) Model – Fact Sheet. April 2025. Retrieved from https://www.cms.gov/files/document/wiser-fact-sheet.pdf
Centers for Medicare & Medicaid Services. WISeR Model Webpage: Innovation Models. Retrieved September 2025 from https://www.cms.gov/priorities/innovation/innovation-models/wiser
Centers for Medicare & Medicaid Services. CMS Launches New Model to Target Wasteful, Inappropriate Services in Original Medicare. Press Release, June 27 2025. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-launches-new-model-target-wasteful-inappropriate-services-original-medicare
Centers for Medicare & Medicaid Services / Federal Register. Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model. Federal Register Notice, July 1 2025 (Document 2025-12195). Retrieved from https://public-inspection.federalregister.gov/2025-12195.pdf
FAQ
Q1: What does the Seniors Deserve SMARTER Care Act of 2025 do, if passed?
It prohibits the Secretary of Health and Human Services from implementing the WISeR Model or any model that is substantially similar within the Medicare program.
(Source)
Q2: Who introduced the bill?
The bill was introduced by Representatives Rick Larsen, Suzan DelBene, Kim Schrier, Greg Landsman, Ami Bera, and Mark Pocan.
(Source)
Q3: What are key concerns raised about the WISeR Model?
The American Hospital Association cited vendor payment structures tied to denials, limited transparency of algorithm-based review tools, potential provider burden, and the short timeframe for implementation.
(Source)
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