{"id":"762428d5-85d3-4e85-9f2c-2ffc6542cc74","feedVisibility":"normal","congress":119,"billType":"hjres","billNumber":187,"title":"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\".","displayTitle":"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\".","abstract":"This joint resolution prohibits the Centers for Medicare & Medicaid Services (CMS) from testing a new Medicare payment model in certain states that involves a prior authorization process and the use of enhanced technology by third-party contractors to determine whether certain claims should be paid. Specifically, the joint resolution nullifies a notice issued by the CMS on July 1, 2025, titled Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model. (On May 12, 2026, the Government Accountability Office issued a letter of opinion stating that this notice constituted an agency rule and is therefore subject to the Congressional Review Act.) The CMS selected six states to participate in this model over a six-year period: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. Under the model, contracted companies must process prior authorization requests (i.e., requests for coverage determinations before a service is furnished) for certain services using enhanced technology (e.g., artificial intelligence). Contracted companies are paid based on the share of resulting savings. The CMS aims to test the model's ability to produce accurate results while streamlining the prior authorization process for Medicare claims. The model is based in part on similar processes used for Medicare Advantage claims. CMS began implementing the model on January 1, 2026. This joint resolution prohibits the CMS from continuing to do so.","displaySummary":"

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Kakanselahin ng resolusyong ito ang isang pederal na panuntunan mula sa Centers for Medicare & Medicaid Services (CMS) na lumikha ng modelong prior-authorization na Wasteful and Inappropriate Services Reduction (WISeR). Sa ilalim ng panuntunan ng CMS, hihilingin ng Medicare ang paunang pag-apruba para sa ilang piling serbisyo bago ito saklawin, isang hakbang na naglalayong bawasan ang di-kailangan o wastong gastos sa pangangalaga. Maaaring gamitin ng Kongreso ang Congressional Review Act upang tutulan ang mga bagong-labas na panuntunan ng ahensya, at ginagamit ng resolusyong ito ang kapangyarihang iyon matapos tapusin ng Government Accountability Office na ang abiso ng WISeR ay kwalipikadong isang pormal na panuntunang sakop ng pagsusuri. Kung maipapasa, ang panuntunan ay hindi na magkakaroon ng bisang legal, ibig sabihin hindi maipapatupad ng CMS ang mga bagong kinakailangan sa prior-authorization para sa mga apektadong serbisyo ng Medicare. Direktang maaapektuhan ng pagbabagong ito ang mga benepisyaryo ng Medicare at ang mga tagapagbigay ng serbisyong nagsisingil sa Medicare para sa mga serbisyong pinag-uusapan.

","status":"INTRODUCED","topics":["HEALTHCARE"],"introducedAt":"2026-05-19T00:00:00+00:00","latestActionAt":"2026-05-19T00:00:00+00:00","congressGovUrl":null,"accountabilityFlags":{"average_household_impact":["↓ Kinakailangang prior-authorization ng Medicare — Binawi para sa piling serbisyo sa ilalim ng pilot na modelong WISeR ng CMS"]},"tldr":"Kinakansela ang patakaran ng Medicare na lumikha ng WISeR model, na sana ay nag-aatas ng paunang pag-apruba para sa piling serbisyo.","summaryStandard":null,"flagExplainers":{},"flagValence":{},"needsResummary":false,"displaySummaryHtml":null,"rawStatusText":"Introduced in House","chamber":"HOUSE","policyArea":"Health","legislativeSubjects":[],"lawStatus":null,"lawNumber":null,"latestActionText":"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.","latestTextVersion":"Introduced in House","textVersionUsed":null,"dateAdded":"2026-07-18T00:00:00+00:00","summarizedAt":null,"recordId":"762428d5-85d3-4e85-9f2c-2ffc6542cc74","feedIdentityKey":"119/hjres/187","websiteBillId":"HJRES-187","yourvoiceSummary":"Kakanselahin ng resolusyong ito ang isang pederal na panuntunan mula sa Centers for Medicare & Medicaid Services (CMS) na lumikha ng modelong prior-authorization na Wasteful and Inappropriate Services Reduction (WISeR). Sa ilalim ng panuntunan ng CMS, hihilingin ng Medicare ang paunang pag-apruba para sa ilang piling serbisyo bago ito saklawin, isang hakbang na naglalayong bawasan ang di-kailangan o wastong gastos sa pangangalaga. Maaaring gamitin ng Kongreso ang Congressional Review Act upang tutulan ang mga bagong-labas na panuntunan ng ahensya, at ginagamit ng resolusyong ito ang kapangyarihang iyon matapos tapusin ng Government Accountability Office na ang abiso ng WISeR ay kwalipikadong isang pormal na panuntunang sakop ng pagsusuri. Kung maipapasa, ang panuntunan ay hindi na magkakaroon ng bisang legal, ibig sabihin hindi maipapatupad ng CMS ang mga bagong kinakailangan sa prior-authorization para sa mga apektadong serbisyo ng Medicare. Direktang maaapektuhan ng pagbabagong ito ang mga benepisyaryo ng Medicare at ang mga tagapagbigay ng serbisyong nagsisingil sa Medicare para sa mga serbisyong pinag-uusapan.","updatedAt":"2026-10-25T00:26:59.063125+00:00"}