This issue is of concerns to most all of us. You might want to take a minute to read, and take appropriate action.

NRLN Action Alert

Opportunity to Stop Prior Authorization

for Traditional Medicare

Click here to ask your members of Congress to vote for legislation to stop the six-states trial requiring prior authorization for several traditional Medicare medical procedures. 

You may recall the NRLN Action Alert in January asking you to send a letter to President Trump requesting that he stop the Centers for Medicare and Medicaid Services’ (CMS) Wasteful and Inappropriate Service Reduction (WISeR) trial.

Although the White House was flooded with Action Alert letters the trial has been going on for more than six months in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. CMS has contracts with for-profit companies who use AI to decide whether a doctor’s request for a patient’s treatment is approved or denied. Requests for approvals are required for a range of procedures, including epidural steroid injections, treatments for spinal stenosis and knee osteoarthritis, and nerve stimulation for conditions such as tremors and Parkinson’s disease.

From the beginning there have been news reports that WISeR has been a disaster. Patients, doctors, and other healthcare professionals have said the trial has created confusion, errors, long waiting times, and stress. Some have described the trial as “horrendous” and say people enrolled in traditional Medicare in the pilot states are now getting ensnared in the same red tape as those with Medicare Advantage.

Now there are opportunities in Congress to stop the trial. Senate Joint Resolution 192 (S.J.Res.192) which would end WISeR has been placed on the Senate Legislative Calendar and is awaiting a floor vote.  A companion measure, H.J.Res.187, has been introduced in the House. If the resolutions are passed by both chambers and is signed by President Trump, CMS would be required to terminate WISeR..

Please take a few minutes to go to https://nrln.org/action-alert/#/home/ to send the NRLN’s sample letter to your Senators and Representative. If you have had experience with prior authorization, including delays and/or denials, add your personalized comments to the letter.

Bill Kadereit, President

National Retiree Legislative Network