| bipartisan-medicare-physician-payment-legislation-introduced | Bipartisan Medicare Physician Payment Legislation Introduced | Latest_News | Shared_Content/News/advocacy-report/2026/April 17/bipartisan-medicare-physician-payment-legislation-introduced | <div class="col-md-12">
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<h5>Apr. 17, 2026</h5>
<h2>Bipartisan Medicare Physician Payment Legislation Introduced</h2>
<p><em>Take action to support federal legislation to improve Medicare payment</em>
</p>
<p>
The recently introduced Provider Reimbursement Stability Act, H.R. 8163, takes a major step in modernizing Medicare physician payment. Introduced by Rep. Greg Murphy, MD, (R-NC), and Rep. Tom Suozzi (D-NY), the bipartisan bill modernizes key budget neutrality rules, ensuring fairness and predictability for medical practices and stability for physicians and patients.
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<p>
According to the American Medical Association, when adjusted for inflation, Medicare reimbursement for physician services has declined 33% from 2001 to 2026. Without capping these damaging cuts to physician Medicare reimbursement and other key reforms, doctors are unable to sustainably run their medical practices and are driven to retire or consider consolidating into larger groups, potentially leading to decreased access for patients in rural and underserved communities.
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<p>
H.R. 8163 promotes reimbursement stability and protects physicians by updating the budget neutrality threshold; mandating that the Centers for Medicare and Medicaid Services evaluate the actual base costs for running a medical practice at least every five years; and revising how CMS addresses incorrect billing codes.
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<p>
Currently, the budget neutrality threshold dictates that if spending increases exceed $20 million in one area, they must be offset by other costs in health care. The $20 million threshold has remained the same since the early 1990s and has never been adjusted for inflation. H.R. 8163 would modernize this outdated provision, providing a long overdue threshold increase to $54.3 million and indexing it every five years based on the cumulative percentage increase in the Medical Economic Index.
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<p>
This bill requires CMS to regularly evaluate medical practice costs (i.e., clinical wage rates, equipment, medical supplies, etc.) to prevent large swings in payment rates. In addition, H.R. 8163 directs CMS to correct major errors in billing code estimates by reviewing actual claims data and making prospective rate adjustments, preventing deep, unnecessary cuts under current budget neutrality guidelines that stem from inaccurate utilization projections.
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<p>
Make your voice heard: <a href="https://www.votervoice.net/BroadcastLinks/mh_0pW4jamO3xc7U0ny5NQ">Contact your member of Congress</a> and urge them to support commonsense Medicare payment reforms by cosponsoring H.R. 8163. This bill is a step in the right direction to promote viability of physician practices and patient access to care.
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</div> | 4/17/2026 12:00:00 AM | 1/1/0001 12:00:00 AM |
| latest-updates-on-wiser-prior-authorization-pilot-program | Latest Updates on WISeR Prior Authorization Pilot Program | Latest_News | Shared_Content/News/advocacy-report/2026/April 17/latest-updates-on-wiser-prior-authorization-pilot-program | <div class="col-md-12">
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<h5>Apr. 17, 2026</h5>
<h2>Latest Updates on WISeR Prior Authorization Pilot Program</h2>
<p><em>Virtix announces Gold Card Program; CMS delays services</em>
</p>
<p>
Responding to concerns raised by our members and guided by our extensive policies around prior authorization, the WSMA continues to raise concerns with the Wasteful and Inappropriate Service Reduction Initiative pilot program that launched earlier this year and applies prior authorization requirements for the first time ever to traditional Medicare plans. Read on for the latest on this priority issue for patients and the physician community.
</p>
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<strong>Virtix Health announces WISeR Gold Card Exemption Program</strong>
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Virtix Health, in coordination with the Centers for Medicare and Medicaid Services, has announced the upcoming launch of the WISeR Gold Card Exemption Program, set to debut July 6. The program will recognize eligible physicians and suppliers in Washington state who consistently meet Medicare coverage criteria by granting exemptions from prior authorization and prepayment review requirements for WISeR services.
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<p>
Physicians achieving gold card status may benefit from streamlined administrative processes and reduced review requirements. A Gold Card Exemption Program <a href="https://virtixhealth.com/wiser_model/gold-carding-program">Fact Sheet</a> is now available through the Virtix Health WISeR Resource Center, and additional program details are available at Virtix Health's <a href="https://virtixhealth.com/wiser_model/gold-carding-program">website</a>.
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<p>
<strong>CMS delays implementation of two WISeR Model services</strong>
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CMS has announced a delay in implementing two services under the WISeR Model pilot, according to a <a href="https://public-inspection.federalregister.gov/2026-06616.pdf">notice</a> published in the Federal Register: deep brain stimulation for essential tremor and Parkinson's disease, and percutaneous image-guided lumbar decompression for spinal stenosis. CMS indicated that a new implementation date for these services will be announced in a future Federal Register notice.
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<strong>WSMA advocacy</strong>
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The WSMA continues to <a href="https://takeaction.wsma.org/wp-content/uploads/2026/03/wsma-follow-up-letter-to-cmmi-03262026.pdf">raise concerns</a> with federal policymakers regarding the WISeR Model, citing its impact on patient access to care and practice operations. Physicians have reported increased administrative burden and delays in care delivery associated with prior authorization requirements. The WSMA remains actively engaged with CMS and congressional stakeholders to advocate for refinements that reduce unnecessary barriers and support timely patient care.
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At WSMA's urging, several members of Washington state's congressional delegation signed onto a <a href="https://aboutbgov.com/blkR">letter</a> urging appropriators to block funding for the model.
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<p>
<strong>Are you subject to WISeR? Share your experience</strong>
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We strongly encourage impacted practices to share their experiences with WISeR with us—including administrative challenges, access issues, and impacts on patient care (positive or negative). The WSMA is uniquely positioned to serve as a conduit between Washington physicians, members of Congress, Virtix, Noridian, CMS, and the media. Your experience under WISeR is critical to informing ongoing congressional oversight and future CMS decision-making. Please contact WSMA Director of Policy Jeb Shepard at <a href="mailto:jeb@wsma.org">jeb@wsma.org</a> to share your feedback.
</p>
</div> | 4/17/2026 12:00:00 AM | 1/1/0001 12:00:00 AM |
| unpacking-the-2026-session-pharmacist-scope-of-practice | Unpacking the 2026 Session: Pharmacist Scope of Practice | Latest_News | Shared_Content/News/advocacy-report/2026/April 17/unpacking-the-2026-session-pharmacist-scope-of-practice | <div class="col-md-12">
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<h5>Apr. 17, 2026</h5>
<h2>Unpacking the 2026 Session: Pharmacist Scope of Practice</h2>
<p><em>WSMA to work with pharmacists on appropriate scope of practice update</em>
</p>
<p>
In recent legislative sessions, the Washington State Pharmacy Association has brought forward legislation to modify pharmacists' scope of practice in Washington state. As part of these efforts, in 2025 the state Department of Health conducted a "sunrise review," a process evaluating the safety and appropriateness of health profession scope expansion proposals. Working in concert with the physician community, WSMA’s advocacy has defeated these proposals in both the legislative and regulatory arenas to date.
</p>
<p>
In response to our concerns on varied legislative frameworks that would have authorized broad independent diagnostic and prescriptive authority for pharmacists (<a href="https://app.leg.wa.gov/billsummary/?BillNumber=6019&amp;Year=2023&amp;Initiative=false">SB 6019</a> from 2024; <a href="https://app.leg.wa.gov/BillSummary/?BillNumber=5513&amp;Year=2025&amp;Initiative=false">SB 5513</a> from 2025; and <a href="https://app.leg.wa.gov/BillSummary/?BillNumber=5924&amp;Year=2025&amp;Initiative=false">SB 5924</a> from 2026), the WSPA significantly narrowed its proposal during the 2026 session with a <a href="https://lawfilesext.leg.wa.gov/biennium/2025-26/Pdf/Bills/Senate%20Bills/5924-S.pdf?q=20260408163632">substitute version of the bill</a>. However, the WSMA maintained concerns with the narrowed approach regarding patient safety, care coordination, technology, and professional standards, among other issues.
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<p>
Despite WSMA's opposition, legislation expanding pharmacists' scope passed the state Senate for the first time with bipartisan support as legislators cited challenges around health care workforce shortages and patients' access to care. Ultimately, the WSMA was able to defeat this proposal during the 2026 session, but considerable momentum remains on this issue at the state Legislature.
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<p>
In advance of the 2027 session, legislative leaders— including a pharmacist legislator in both the House and Senate— have urged the WSMA to work with pharmacists on a compromise using the amended, narrowed version of the bill as a starting point. The WSMA respects its pharmacist colleagues and will work in good faith to try to find agreement on revisions to pharmacists' scope of practice that will appropriately expand access to care while ensuring patient safety guardrails. We will keep you updated in future Advocacy Reports with any developments on these discussions.
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</div> | 4/17/2026 12:00:00 AM | 1/1/0001 12:00:00 AM |