Seniors Deserve SMARTER Care Act of 2025
- Bill Number
- H.R. 5940
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-11-07: 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.
- Last Updated
- 2026-06-30T08:07:00Z
AI-Generated Summary
Purpose
This legislation aims to prevent the U.S. Department of Health and Human Services (HHS) from rolling out a new Medicare payment and service delivery model called the WISeR (Wasteful and Inappropriate Services Reduction) model. The WISeR model involves requiring prior authorization—a pre-approval process—for certain Medicare services to reduce what the government sees as unnecessary or wasteful spending. By blocking this, the bill seeks to ensure smoother and faster access to medical care for Medicare recipients, particularly seniors recovering from illnesses or procedures.
Key Provisions
- Prohibition on Implementation: The HHS Secretary is barred from implementing the WISeR model as outlined in a July 1, 2025, Federal Register notice (90 Fed. Reg. 28749), which details prior authorization requirements for select Medicare services.
- Scope of Ban: The prohibition extends to any model substantially similar to WISeR, preventing workarounds or revised versions.
- Short Title: The bill is named the "Seniors Deserve Streamlined Medical Approvals for Timely, Efficient Recovery Care Act of 2025" or the "Seniors Deserve SMARTER Care Act of 2025."
Significant Changes to Existing Law
- This bill would amend Medicare rules by halting a planned expansion of prior authorization processes, which are already used in some Medicare programs but were set to broaden under WISeR.
- It maintains the current Medicare framework without introducing these new administrative requirements, avoiding changes that could add paperwork and delays for providers and patients.
Potential Impacts
- On Government Agencies: HHS and the Centers for Medicare & Medicaid Services (CMS) would not need to allocate resources for developing, testing, or enforcing the WISeR model, potentially saving administrative costs but limiting tools for cost control in Medicare.
- On Citizens: Medicare beneficiaries, especially older adults and those needing post-recovery care, could avoid delays in receiving services due to prior approval requirements, leading to timelier treatment and reduced frustration with bureaucracy.
- On International Relations: No direct impacts, as this is a domestic healthcare policy focused on U.S. Medicare.
Main Stakeholders Affected
- Medicare Beneficiaries: Primarily seniors (over 65) and people with disabilities enrolled in Medicare, who may benefit from fewer barriers to care.
- Healthcare Providers: Doctors, hospitals, and clinics that serve Medicare patients, as they would not face additional prior authorization burdens that could slow down reimbursements and operations.
- Government Entities: HHS and CMS, which proposed the WISeR model to curb wasteful spending but would be restricted from proceeding.
- Advocacy Groups: Organizations representing seniors (e.g., AARP) and healthcare providers, who may support or oppose based on views of administrative efficiency versus access to care.
Notable Legal, Constitutional, or Political Implications
- Legal Implications: The bill enforces congressional oversight of executive agency actions (like CMS rule-making), potentially setting a precedent for blocking specific regulatory models via legislation. It does not challenge the overall authority of HHS to manage Medicare but targets this one initiative.
- Constitutional Implications: None significant, as it aligns with Congress's power to regulate federal programs like Medicare under the Spending Clause of the Constitution.
- Political Implications: Introduced by a bipartisan group of 22 House members (mostly Democrats), it reflects concerns over increasing administrative hurdles in healthcare. If passed, it could influence future Medicare reforms by prioritizing patient access over cost-saving measures, amid ongoing debates about program sustainability and efficiency. The bill was referred to the House Committees on Ways and Means and Energy and Commerce for review.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. DelBene, Suzan K. [D-WA-1]
Cosponsors (43)
Rep. Bera, Ami [D-CA-6], Rep. Landsman, Greg [D-OH-1], Rep. Schrier, Kim [D-WA-8], Rep. Larsen, Rick [D-WA-2], Rep. Pocan, Mark [D-WI-2], Rep. Budzinski, Nikki [D-IL-13], Rep. Castor, Kathy [D-FL-14], Rep. Courtney, Joe [D-CT-2], Rep. Craig, Angie [D-MN-2], Rep. Dexter, Maxine [D-OR-3], Rep. Dingell, Debbie [D-MI-6], Rep. Frankel, Lois [D-FL-22], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Jackson, Jonathan L. [D-IL-1], Rep. Jayapal, Pramila [D-WA-7], Rep. Larson, John B. [D-CT-1], Rep. Randall, Emily [D-WA-6], Rep. Schneider, Bradley Scott [D-IL-10], Rep. Simon, Lateefah [D-CA-12], Rep. Smith, Adam [D-WA-9], Rep. Stanton, Greg [D-AZ-4], Rep. Strickland, Marilyn [D-WA-10], Rep. Thompson, Mike [D-CA-4], Rep. Veasey, Marc A. [D-TX-33], Rep. Khanna, Ro [D-CA-17], Rep. Goldman, Daniel S. [D-NY-10], Rep. Balint, Becca [D-VT-At Large], Rep. Johnson, Julie [D-TX-32], Rep. Ross, Deborah K. [D-NC-2], Rep. McGovern, James P. [D-MA-2], Rep. Beatty, Joyce [D-OH-3], Rep. Pingree, Chellie [D-ME-1], Rep. Grijalva, Adelita S. [D-AZ-7], Rep. Walkinshaw, James R. [D-VA-11], Rep. McClellan, Jennifer L. [D-VA-4], Rep. Titus, Dina [D-NV-1], Rep. DeSaulnier, Mark [D-CA-10], Rep. Soto, Darren [D-FL-9], Rep. Garamendi, John [D-CA-8], Rep. Thanedar, Shri [D-MI-13], Rep. Jacobs, Sara [D-CA-51], Rep. Sánchez, Linda T. [D-CA-38], Rep. Cisneros, Gilbert Ray [D-CA-31]
Recent Actions
- 2025-11-07: 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.
- 2025-11-07: 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.
- 2025-11-07: Introduced in House
- 2025-11-07: Introduced in House
Bill Versions
- Seniors Deserve Streamlined Medical Approvals for Timely, Efficient Recovery Care Act of 2025 — issued 2025-11-07 — PDF (2 pages)