Democratic lawmakers in the Senate and House of Representatives introduced resolutions on Wednesday that seek to roll back new Medicare prior authorization requirements under the Wasteful and Inappropriate Service Reduction (WISeR) model.
Sens. Ron Wyden, D-Ore., Maria Cantwell, D-Wash., Richard Blumenthal, D-Conn., and Kirsten Gillibrand, D-N.Y., called to invoke the Congressional Review Act (CRA) through the resolution (PDF). A companion resolution (PDF) was introduced in the House by Reps. Suzan DelBene, D-Wash., and Greg Landsman, D-Ohio.
It comes a week after the U.S. Government Accountability Office (GAO) determined that the model is subject to the CRA, meaning it should have been submitted to Congress prior to its implementation. With this determination (PDF), legislators have 60 days to force a vote on the resolution of disapproval to repeal the model.
The WISeR model is a year-long, six-state pilot program unveiled by the Centers for Medicare & Medicaid Services’ Innovation Center (CMMI) last July. It aims to expedite prior authorizations using artificial intelligence for 13 medical services deemed “low-value” or “vulnerable” to misuse. It launched Jan. 1 in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington.
In a statement, DelBene said the model is a “dangerous program that is denying care to Medicare patients so companies can profit.”
“In just the first few months of the program, we’ve seen stories from across Washington state of seniors suffering while conditions worsen as they await approval for treatments their doctor prescribed,” DelBene said. “This program implements the same flawed prior authorization scheme from Medicare Advantage into traditional Medicare. If scaled up, it would be a back door to privatizing Medicare. It is causing needless delays, worsening conditions, and costing us more in the long-run. Congress needs to step up and put an end to WISeR,”
It’s the latest attempt from Democratic lawmakers to roll back the model. In November, a group of six Representatives, including DelBene, introduced a bill to prohibit its launch, though it ultimately failed to gain any traction.
The model has raised concerns among provider groups, including the American Hospital Association and the American Medical Association, as well as advocates and legislators alike.
In April, Cantwell released a report based on data from 16 Washington hospitals that found procedure completion took twice to four times as long after the program’s implementation, following authorization delays.
Other issues raised by the report included concerns from hospitals about increased administrative burdens and conflicts of interest resulting from the program’s structure.
“For Washington’s seniors, WISeR is overriding doctors to delay care and deny treatment,” Cantwell said in a May 20 statement. “My constituents should not have to suffer through 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 put a stop to WISeR.”