This bill, called the I CAN Act, would change parts of Medicare (Title XVIII) and Medicaid (Title XIX) to let advanced practice registered nurses do more for patients. It adds or clarifies roles for nurse practitioners, physician assistants, clinical nurse specialists, certified registered nurse anesthetists (CRNAs), and certified nurse-midwives. Key changes include expanding who can prescribe cardiac and pulmonary rehab exercise; allowing nurse practitioners and physician assistants to meet documentation rules for certain diabetic shoes; expanding medical nutrition therapy; letting more providers establish home infusion therapy plans; updating hospice billing so nurse practitioners can bill in the same way as physicians for some services; allowing nurse practitioners to certify post-hospital extended care and supervise some services in skilled nursing and nursing facilities; and improving access to Medicaid clinic services. For CRNAs, the bill clarifies they can be reimbursed for evaluation and management services, can order or refer services to the extent allowed by State law, removes a federal requirement that they be supervised by a physician, and makes CRNA services a required Medicaid benefit with a payment rule specified. For nurse-midwives, the bill supports clinical training, home health services, and access to durable medical equipment and supplies. The bill also changes the Medicare local coverage determination (LCD) process to require more transparency about evidence and expert advice, to prohibit contractors from adding practitioner qualification limits, and to allow challenges once an LCD is posted. It also adds locum tenens rules for advanced practice nurses. Most changes take effect 90 days after enactment, except the ACO assignment change and the LCD transparency rules; the bill lets HHS use interim final rules or guidance to implement provisions when needed.
For patients: More kinds of advanced practice nurses could provide, order, or certify services covered by Medicare and Medicaid. This may change which clinician signs orders, certifies care, or bills for services in settings like hospice, home health, skilled nursing, and clinics. For nurses and other clinicians: The bill would allow nurse practitioners, CRNAs, nurse-midwives, and some other advanced practice nurses to perform, order, certify, or bill for more services to the extent allowed by State law. CRNAs would be explicitly allowed to bill for certain evaluation and management services and to order or refer services under State law. Hospitals and facilities would see updated rules about supervision, certification, and clinical privileges for advanced practice nurses. For administrators and contractors: Medicare contractors must publish more information used to set local coverage decisions and cannot impose additional practitioner qualification limits for covered items or services.
No publicly available information.
The bill text states its purpose is "to increase access to services provided by advanced practice registered nurses under the Medicare and Medicaid programs" and contains many specific changes aimed at removing barriers to practice. Provisions in the bill expand which advanced practice nurses may prescribe, certify, order, bill for, or supervise care in federal programs, and increase transparency in how Medicare contractors make local coverage determinations. The bill also includes deadlines for the Secretary of Health and Human Services to update certain regulations.
No publicly available information.