Democratic members of the House and Senate introduced a resolution Wednesday calling for the repeal of new Medicare prior authorization requirements under the Wasted and Improper Service Reduction (WISeR) model.
Sens. Ron Wyden of Oregon, Maria Cantwell of Washington, Richard Blumenthal of Connecticut, and Kirsten Gillibrand of New York called for the Congressional Review Act (CRA) to be invoked through a resolution (PDF). A companion resolution (PDF) was introduced in the House by Reps. Susan DelBene, D-Wash., and Greg Landsman, D-Ohio.
This comes a week after the U.S. General Accounting Office (GAO) determined the model was subject to the CRA. This means the model should have been submitted to Congress before it was introduced. The decision (PDF) gives lawmakers 60 days to force a vote on a resolution to repeal the model.
The WISeR model is a one-year pilot program in six states that was announced last July by the Centers for Medicare and Medicaid Services’ Innovation Center (CMMI). It aims to use artificial intelligence to speed up pre-approval for 13 medical services deemed to be of “low value” or “vulnerable” and vulnerable to exploitation. The service launched on January 1st in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington.
DelBene said in a statement that the model is a “dangerous program in which corporations deny care to Medicare patients in order to make a profit.”
“In the first few months of the program, we have seen stories from across Washington state of older adults whose conditions have worsened as they wait for their doctor-prescribed treatment to be approved,” DelBene said. “This program introduces the same flawed prior authorization scheme into traditional Medicare as Medicare Advantage. At scale, it would become a backdoor to Medicare privatization, causing unnecessary delays, worsening conditions, and more costs in the long run. Congress needs to step up and put an end to WISeR.”
This is the latest attempt by Democratic lawmakers to roll back the model. In November, a group of six lawmakers, including Del Bene, introduced a bill to ban the launches, but it ultimately failed to gain any traction.
The model has raised concerns among health care provider groups, advocates and lawmakers alike, including the American Hospital Association and the American Medical Association.
In April, Cantwell released a report based on data from 16 hospitals in Washington state, which found that procedures took two to four times longer to complete after implementing the program due to delays in accreditation.
Other issues raised by the report included concerns from hospitals about increased administrative burden and conflicts of interest due to the program’s structure.
“WISeR overrides the ability of doctors to delay or deny care to Washington’s seniors,” Cantwell said in a May 20 statement. “My constituents should not suffer from bureaucratic delays disguised as modernization. This pilot program should never have been implemented without Congressional oversight, and I call on my colleagues to stand up for Medicare patients and stop WISeR.”
