Seniors Deserve SMARTER Care Act of 2025
- Sponsor
- Rep. DelBene, Suzan K. [D-WA-1]
- Committees
- Energy and Commerce Committee (primary)
- Last action
- Nov 7, 2025
Bottom line
The bill aims to prevent the Centers for Medicare & Medicaid Services (CMS) from implementing a new prior authorization model for Medicare services, which proponents argue would streamline care for seniors.
What it actually does
This bill prohibits the Secretary of Health and Human Services from implementing the "Wasteful and Inappropriate Services Reduction (WISeR) Model" under the Medicare program. It specifically references a notice in the Federal Register (90 Fed. Reg. 28749 (July 1, 2025)) that describes this model, which involves prior authorization for select services. The prohibition also extends to any substantially similar model.
Proponents argue
Supporters of H.R. 5940 argue that the WISeR model, by expanding prior authorization requirements, would create unnecessary administrative burdens for healthcare providers and delay access to medically necessary care for Medicare beneficiaries. They contend that such models can lead to poorer health outcomes and increased costs due to delayed treatments, asserting that seniors deserve timely and efficient recovery care without additional bureaucratic hurdles.
Opponents contend
Opponents of this bill (i.e., proponents of the WISeR model) would argue that the WISeR model is designed to reduce wasteful and inappropriate services, thereby protecting Medicare funds and ensuring that only medically necessary services are provided. They would contend that prior authorization is a crucial tool for program integrity, cost containment, and preventing fraud, waste, and abuse within the Medicare system, ultimately benefiting taxpayers and the long-term solvency of the program.
The bill is exceptionally short and straightforward, requiring minimal time to read and understand its core intent.
Section 2
Prohibition on WISeR Model Implementation
This section explicitly forbids the Secretary of Health and Human Services from putting into effect the "Wasteful and Inappropriate Services Reduction (WISeR) Model" within the Medicare program. It also prevents the implementation of any other model that is largely similar to WISeR, ensuring that the specific prior authorization framework outlined in the July 1, 2025 Federal Register notice cannot be used.
Supporters argue
Supporters argue that preventing the WISeR model ensures that Medicare beneficiaries receive timely access to necessary medical services without facing additional bureaucratic hurdles that could delay treatment and negatively impact health outcomes. They contend it reduces administrative overhead for providers, allowing them to focus more on patient care.
Critics contend
Opponents of this prohibition (i.e., those who support the WISeR model) would argue that blocking the model undermines efforts to control Medicare spending and prevent fraud, waste, and abuse. They believe prior authorization is a necessary tool to ensure fiscal responsibility and the appropriate use of healthcare resources, ultimately protecting the Medicare trust fund.
Tradeoffs
This provision balances the desire to reduce administrative burden and potential care delays for beneficiaries and providers against the government's interest in controlling costs and ensuring program integrity through mechanisms like prior authorization.