Seniors Deserve Streamlined Medical Approvals for Timely, Efficient Recovery Care Act of 2025; Seniors Deserve SMARTER Care Act of 2025
Summary
The "Seniors Deserve Streamlined Medical Approvals for Timely, Efficient Recovery Care Act of 2025," also known as the "Seniors Deserve SMARTER Care Act of 2025," aims to prevent the Secretary of Health and Human Services from implementing the Wasteful and Inappropriate Services Reduction (WISeR) model under the Medicare program. This bill was introduced in the Senate on December 15, 2025. The WISeR model involves prior authorization for select services under Medicare.
The bill specifically targets the model described in the Federal Register notice (90 Fed. Reg. 28749) published on July 1, 2025. It also prohibits the implementation of any substantially similar model.
The bill is sponsored by Mrs. Murray and several other senators, and it has been referred to the Committee on Finance.
Expected Effects
If enacted, this bill would prevent the implementation of the WISeR model, which requires prior authorization for certain Medicare services. This would mean that Medicare beneficiaries would not be subject to the prior authorization requirements associated with the WISeR model.
Healthcare providers would also be affected, as they would not need to seek prior authorization for the services targeted by the WISeR model. This could potentially reduce administrative burdens for providers.
The long-term effects would depend on the actual impact of the WISeR model on healthcare costs and patient outcomes, which are currently unknown.
Potential Benefits
- Potentially reduces administrative burdens for healthcare providers by eliminating the need for prior authorization under the WISeR model.
- May lead to quicker access to certain medical services for Medicare beneficiaries by removing the prior authorization step.
- Could prevent potential disruptions in patient care that might arise from delays in prior authorization approvals.
- Might reduce patient frustration and anxiety associated with navigating prior authorization processes.
- Could allow healthcare providers to focus more on patient care rather than administrative tasks related to prior authorizations.
Potential Disadvantages
- May lead to increased healthcare costs if the WISeR model was indeed effective in reducing wasteful or inappropriate services.
- Could potentially result in the provision of unnecessary or inappropriate medical services if prior authorization is not required.
- Might hinder efforts to control healthcare spending and ensure the appropriate utilization of Medicare resources.
- Could reduce the ability of the Secretary of Health and Human Services to test innovative payment and service delivery models aimed at improving the efficiency of the Medicare program.
- Potential for increased fraud and abuse if prior authorization is removed as a safeguard.
Constitutional Alignment
The bill appears to align with the general structure of the US Constitution, particularly Article I, Section 1, which vests legislative powers in Congress. Congress has the authority to enact laws related to federal programs like Medicare.
There are no apparent conflicts with specific constitutional rights or amendments. The bill does not infringe upon individual liberties, rights, or privacy.
However, the constitutionality of the underlying WISeR model itself, which this bill seeks to prevent, is not addressed directly. The bill simply exercises Congress's power to regulate federal programs.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).