Nurses gain broader Medicare roles

Summary#

The Improving Care and Access to Nurses Act, or I CAN Act, would amend the Social Security Act’s Medicare and Medicaid rules and make a smaller change to a Public Health Service Act grant rule. Its stated goal is to increase access to services provided by advanced practice registered nurses; it does not create a new health program. The bill was introduced in the Senate and referred to committee, so it is not law.

  • Nurse practitioners, physician assistants, clinical nurse specialists and certified nurse-midwives could provide, order, certify or document additional Medicare-covered services, including rehabilitation, nutrition therapy, home health and equipment-related services.
  • Nurse practitioners could take on more care and certification duties in hospitals, skilled nursing facilities and Medicaid-covered settings. Some changes expressly depend on state law.
  • Certified registered nurse anesthetists (CRNAs) would gain Medicare payment and referral authority for certain services. Medicaid would have to cover authorized CRNA services and pay at least the specified Medicare-based amount.
  • The bill would bar Medicare contractors from limiting coverage based on the qualifications of certain practitioners, require more public information about local coverage decisions, and allow a civil penalty of up to $10,000 for each specified failure.
  • It would allow certain Medicare billing rules for temporary replacement clinicians (locum tenens) to apply to these advanced practice providers, and change the certification requirement for nurse-midwives to certification by the American Midwifery Certification Board or a successor.

What it means for you#

  • Patients with Medicare or Medicaid: More types of practitioners could provide or certify some covered services. The bill does not guarantee that a service will be available nearby or change every coverage rule.
  • Nurse practitioners, physician assistants, clinical nurse specialists, CRNAs and nurse-midwives: The bill would expand their roles in named federal health-program rules. Where the bill makes authority subject to state law, state limits would still matter.
  • Hospitals and nursing facilities: Nurse practitioners could perform additional certification and care duties under Medicare and Medicaid rules. The bill does not set out a new application or review process for patients.
  • Medicare contractors: They would have to publish specified information about local coverage decisions and could face penalties for failing to do so or for imposing prohibited practitioner-qualification limits.
  • Taxpayers and state Medicaid programs: The bill would require payment for some additional services, but does not provide a cost estimate.

Money#

No cost information is included in the supplied material. No publicly available information on a fiscal estimate was supplied.

  • Medicaid would have to cover authorized CRNA services and pay no less than the bill’s specified Medicare-based amount.
  • Expanding who may provide or certify covered services could affect Medicare and Medicaid spending; the bill gives no estimate of that effect.
  • The bill sets a possible civil penalty of up to $10,000 for each specified failure by a Medicare contractor. It does not establish a new tax or fee.

What is unclear#

  • The Social Security Act and other parent laws were not supplied, so the current rules—and the precise change from current law—could not be verified.
  • The bill refers to an “applicable provider” for home-infusion plans, but the supplied text does not include that term’s definition.
  • The bill does not explain how expanded provider authority would interact with state rules beyond the provisions that expressly refer to state law.
  • It gives no estimate of staffing, implementation or service costs, and no details on how often the new authorities would be used.
  • Most changes would start 90 days after enactment; some have different dates or deadlines. The bill does not specify when it would be enacted, and passage is uncertain.

Case for#

  • The bill appears intended to remove federal payment and certification barriers that can prevent advanced practice nurses from providing services they are authorized to perform.
  • Allowing more qualified practitioners to certify or provide named services could give patients more ways to access covered care.
  • The bill keeps state law limits in place where it expressly says those limits apply.
  • Requiring Medicare contractors to disclose more of the basis for local coverage decisions could make those decisions easier to examine.

Case against#

  • The bill expands provider roles across many services, but the supplied material does not provide evidence about the effects on care quality or patient outcomes.
  • More services may be billed to Medicare and Medicaid, but the bill supplies no spending estimate.
  • The bill does not guarantee that providers will be available or that access will improve in practice.
  • The limits and processes for some new authorities are not fully explained in the supplied text, making the practical scope difficult to assess.