SJRES-192-119
Placed on Senate Legislative Calendar under General Orders. Calendar No. 431.
Sponsored by Ron Wyden (D-OR)
What it does
This joint resolution would use the Congressional Review Act (CRA) to nullify a rule issued by the Centers for Medicare & Medicaid Services (CMS) on July 1, 2025, known as the WISeR (Wasteful and Inappropriate Services Reduction) Model. That rule established a prior authorization program requiring Medicare providers to obtain advance approval from CMS before delivering certain selected services. If enacted, the resolution would void the rule entirely, and under the CRA, CMS would be prohibited from issuing a substantially similar rule without new congressional authorization.
Who benefits
Medicare beneficiaries who would otherwise face delays in accessing services subject to prior authorization requirements. Physicians, hospitals, and other healthcare providers who would avoid the administrative burden of submitting prior authorization requests to CMS. Medical specialty groups whose services are targeted by the WISeR model. Healthcare staffing and billing departments that would not need to implement new compliance workflows. Patients with time-sensitive conditions where treatment delays could worsen outcomes.
Who is hurt
Federal taxpayers and the Medicare program, which would lose a mechanism CMS designed to reduce spending on services it identified as wasteful or inappropriate. Medicare fiscal integrity efforts broadly, as the rule was intended to curb overutilization. Future CMS rulemaking flexibility, since a successful CRA disapproval bars substantially similar rules without new legislation. Potentially, Medicare beneficiaries who might have been protected from receiving low-value or unnecessary procedures.
Supporters argue
Supporters argue that prior authorization requirements create dangerous delays in patient care — studies, including a 2023 AMA survey, found that 93% of physicians reported care delays due to prior authorization, and 25% reported serious adverse patient events as a result. They contend that CMS's WISeR model extends a burdensome insurance-industry practice into Medicare, a program that has historically provided relatively direct access to care, and that the administrative costs imposed on providers would ultimately be passed on to the healthcare system without proportionate savings.
Opponents argue
Opponents argue that prior authorization is a proven tool for reducing wasteful spending in Medicare, which the Government Accountability Office and HHS Inspector General have repeatedly identified as vulnerable to billions of dollars in improper payments annually. They contend that the WISeR model was narrowly targeted at a select set of high-waste services and that eliminating it removes a cost-control mechanism without replacing it, accelerating Medicare's long-term fiscal pressures at a time when the program's trust fund faces projected shortfalls.
Constitutional context
Congress has broad authority over Medicare under the Taxing and Spending Clause (Art. I, §8, cl. 1), and the CRA is a valid exercise of that authority to reclaim legislative control over agency rulemaking. Post-Loper Bright (2024), courts no longer defer to CMS's interpretation of its own statutory authority, meaning the underlying WISeR rule itself could face independent judicial scrutiny over whether CMS had clear congressional authorization to impose prior authorization at this scale — a concern the major questions doctrine from West Virginia v. EPA (2022) could amplify.
Checks and balances
Congress would gain authority by nullifying the CMS rule and blocking substantially similar future rules; the executive branch (CMS/HHS) loses rulemaking power in this area unless Congress passes new authorizing legislation.
Historical precedent
Congress has used the Congressional Review Act to nullify agency rules on multiple occasions since 2017, when it was used 14 times in a single session to void Obama-era regulations, though CRA disapprovals of Medicare-specific payment and delivery model rules are rare.