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Block Medicare Prior Authorization Rule

Full Title:
A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services of the Department of Health and Human Services relating to "Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model".

Summary#

This joint resolution would nullify a Centers for Medicare & Medicaid Services (CMS) rule that implements prior authorization for certain services under the Wasteful and Inappropriate Services Reduction (WISeR) model. The resolution says the rule (published July 1, 2025) is disapproved and “shall have no force or effect.” It cites a Government Accountability Office letter finding the CMS notice is a rule under chapter 8 of title 5, United States Code (the Congressional Review Act).

  • Main change: If enacted, the CMS rule implementing prior authorization under the WISeR model would be repealed and would not take effect.
  • Who is affected: The Medicare program, providers who would have faced new prior-authorization requirements, and Medicare beneficiaries who receive the targeted services.
  • Legal basis: The resolution uses the authority in chapter 8 of title 5 (the Congressional Review Act) to disapprove a federal agency rule.
  • Current status: The resolution was introduced in the Senate and placed on the legislative calendar.

What it means for you#

  • Medicare beneficiaries: If the resolution becomes law, certain services that CMS had planned to require prior approval for under the WISeR model would not be subject to that new prior-authorization process. The bill text does not list which services or beneficiaries would have been affected.
  • Doctors, hospitals, and other providers: Providers who would have needed to submit prior-authorization requests for selected WISeR services would not have to follow the CMS prior-authorization process while this disapproval is in effect.
  • Medicare program administrators (CMS): CMS would not be able to implement the specific prior-authorization rule referenced in the resolution. The resolution itself does not describe how CMS should proceed after disapproval.
  • Taxpayers and the public: The resolution stops this particular administrative change to Medicare. The bill does not say whether other measures to reduce waste or inappropriate services would continue.

Expenses#

No publicly available information.

  • The resolution text and the supplied materials do not include a fiscal note or estimates of costs or savings.
  • The resolution does not state any new spending, fees, or funding changes.
  • It is not clear from the provided material whether disapproving the rule would increase or decrease Medicare spending, administrative costs for CMS, or paperwork and compliance costs for providers.

Proponents' View#

  • The resolution appears intended to overturn CMS’s planned prior-authorization rule for certain WISeR services.
  • Supporters may argue that blocking the rule would prevent new administrative burdens on providers and reduce delays or barriers for patients seeking care.
  • Supporters may also view the GAO finding (that the CMS notice is a rule subject to the Congressional Review Act) as a proper legal basis for congressional review and disapproval.

Opponents' View#

  • One concern is that reversing the CMS prior-authorization rule could limit CMS tools to reduce wasteful or inappropriate services, which might affect program integrity and spending.
  • The resolution does not explain which services were targeted or how CMS would otherwise address the waste or inappropriate use the WISeR model aims to reduce.
  • It is unclear what the longer-term effects would be on Medicare program management, because the resolution only states the rule “shall have no force or effect” and gives no guidance on alternatives or next steps.