Providing for Congressional Disapproval Under Chapter 8 of Title 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

Floor Speech

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Mr. CRAPO. Madam President, in response to the discussion that my colleague from Oregon has just engaged in, far too often, our Nation's healthcare system incentivizes low-value, high-cost services. For years, bipartisan policy makers throughout Capitol Hill and across administrations have endeavored to disrupt this flawed paradigm, especially in the Medicare Program. Unfortunately, despite progress to incorporate new value-based payment arrangements, Medicare's underlying reimbursement structure continues to rely heavily on the volume of services provided, rather than the quality of care.

In addition to failing patients and providers, Medicare's perverse financial incentives contribute to massive waste and abuse. Well- meaning clinicians often face opaque coverage guidelines that can result in denied reimbursements, while malicious actors exploit bureaucratic vulnerabilities to defraud the program.

Through the wasteful and inappropriate service reduction model--work WISeR--CMS is testing whether enhanced technology can help address these systemic failures. For a limited set of nonemergency services with a documented history of abuse and overuse, providers in select States must submit claims for review. Claims that meet existing Medicare coverage requirements are quickly approved, offering providers payment predictability.

When issues arise, board-certified clinicians--not technological machines, board-certified clinicians--intervene to make the final decision. The potential benefit of this ``detect and prevent strategy'' is substantial. For example, Medicare spending on skin substitutes, one of the chosen WISeR model services, increased and--hear this--increased from $256 million in 2019 to $10 billion in 2024. It doesn't even take a technological machine to tell you that something is wrong there.

Proactive, technology-based scrutiny could have detected this outlier spending growth and protected both patients and taxpayers.

Regrettably, misinformation about this model has sparked fears of delays in essential patient care and additional burdens on providers.

Later today, the Senate will proceed to a resolution to stop this important work of the WISeR model. Every Member of this body agrees that patients should have access to high-quality care, providers deserve predictable payment for services, and avoidable waste, fraud, and abuse in Medicare should be stopped. Ending this pilot program prematurely will deprive CMS of a useful tool to accomplish each of those goals.

And I urge my colleagues to consider the facts and oppose this resolution.

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