HJRES-187-119
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sponsored by Greg Landsman (D-OH)
What it does
This joint resolution would use the Congressional Review Act to disapprove a CMS rule establishing the "Wasteful and Inappropriate Services Reduction (WISeR) Model," which implements prior authorization requirements for select Medicare services. If enacted, the rule would have no force or effect, and CMS would be barred from issuing a substantially similar rule without new statutory authorization.
Who benefits
Medicare beneficiaries and providers in the pilot regions who would otherwise face prior authorization requirements for selected services would avoid those extra approval steps. Physician groups and hospitals that have raised concerns about administrative burden and treatment delays from prior authorization may benefit from reduced paperwork.
Who is hurt
CMS would lose its ability to test this specific cost-control approach, potentially limiting efforts to identify wasteful or inappropriate Medicare spending. Taxpayers and the Medicare Trust Fund could see reduced savings that CMS projected from screening out unnecessary services, and vendors or contractors set up to administer the prior authorization model would lose that work.
Supporters argue
Supporters argue that prior authorization requirements in Medicare, even as a pilot, risk delaying necessary care for seniors and disabled beneficiaries, echoing complaints from patient advocates and physician groups about similar requirements in Medicare Advantage plans. They contend that CMS should not test administratively burdensome utilization controls on traditional Medicare beneficiaries without explicit congressional authorization, especially given documented instances of prior authorization denials for medically necessary care in other contexts.
Opponents argue
Opponents argue that the WISeR Model was designed specifically to identify and reduce wasteful or inappropriate services, and that eliminating it removes a tool for controlling Medicare spending growth without proposing any alternative approach. They contend that blocking a limited pilot program before it can generate data on its effects on cost and care quality prevents evidence-based evaluation of whether prior authorization could reduce waste while preserving beneficiary access.
Constitutional context
This resolution operates under the Congressional Review Act (5 U.S.C. Chapter 8), which allows Congress to overturn agency rules by joint resolution with presidential signature or veto override, reflecting Congress's Article I authority to check executive branch rulemaking. It raises no independent constitutional question beyond this statutory review mechanism, though the underlying dispute over whether prior authorization requirements exceed CMS's Medicare statutory authority could face post-Loper Bright judicial scrutiny if the rule were left in place.
Checks and balances
Congress would exercise its legislative check on executive agency rulemaking by nullifying a CMS regulation; the President retains a veto check on this resolution, and if enacted, CMS could not issue a substantially similar rule absent new congressional authorization.
Historical precedent
Congress has used the Congressional Review Act numerous times since 1996 to overturn agency rules, including several healthcare-related regulations, though such resolutions require presidential signature or a veto override to take effect.