I CAN Act
- Bill Number
- H.R. 1317
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-02-13: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2026-07-01T08:09:20Z
AI-Generated Summary
Purpose of the Legislation
The "Improving Care and Access to Nurses Act" (I CAN Act), H.R. 1317, aims to expand access to healthcare services provided by advanced practice registered nurses (APRNs)—including nurse practitioners, certified registered nurse anesthetists (CRNAs), and certified nurse-midwives—under Medicare (Title XVIII of the Social Security Act) and Medicaid (Title XIX). It removes barriers to their practice, such as supervision requirements and reimbursement limitations, to improve patient care, particularly in rehabilitation, hospice, home health, and other settings.
Key Provisions
The bill is structured into five titles, focusing on specific types of APRNs and broader improvements:
- Title I: Removal of Barriers for Nurse Practitioners
- Expands eligibility for cardiac and pulmonary rehabilitation programs under Medicare by allowing nurse practitioners, physician assistants, or clinical nurse specialists to prescribe exercise and supervise programs (previously limited to physicians).
- Permits nurse practitioners and physician assistants to document the need for therapeutic shoes for Medicare beneficiaries with diabetes.
- Improves beneficiary assignment in the Medicare Shared Savings Program by including primary care services provided by certain APRNs starting in 2026.
- Broadens access to medical nutrition therapy services under Medicare to include referrals from nurse practitioners, clinical nurse specialists, or physician assistants.
- Allows "applicable providers" (including nurse practitioners) to establish plans for home infusion therapy under Medicare.
- Increases access to hospice care by authorizing nurse practitioners to certify eligibility, bill for services, and provide care (with payment at 85% of the physician fee schedule rate).
- Streamlines care in skilled nursing facilities (SNFs) and nursing facilities by allowing nurse practitioners to supervise residents and certify services under Medicare and Medicaid; also authorizes nurse practitioners to care for inpatient hospital patients.
- Improves Medicaid coverage for clinic services by including those provided by nurse practitioners.
- Title II: Removal of Barriers for Certified Registered Nurse Anesthetists (CRNAs)
- Clarifies Medicare reimbursement for CRNAs' evaluation and management services, including pre-anesthesia care.
- Revises regulations to allow CRNAs to order, certify, and refer services under Medicare to the extent permitted by state law.
- Establishes a special payment rule under the physician fee schedule for teaching student registered nurse anesthetists.
- Removes federal requirements for physician supervision of CRNAs in Medicare-covered services (while preserving state authority).
- Mandates CRNA services as a required Medicaid benefit, with payments at least matching Medicare rates using the same methodology.
- Title III: Removal of Barriers for Certified Nurse-Midwives
- Enhances Medicare payments for supervision of interns or residents in maternity care training provided by certified nurse-midwives.
- Improves access to Medicare home health services by allowing certified nurse-midwives to establish and certify plans of care.
- Expands access to durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) for Medicare beneficiaries through referrals from certified nurse-midwives.
- Makes technical updates to certification requirements, specifying recognition by the American Midwifery Certification Board.
- Title IV: Improvements for All Advanced Practice Registered Nurses
- Revises the Medicare local coverage determination (LCD) process: requires contractors to disclose expert advice, communications, and criteria used; prohibits imposing qualification limits on physicians or APRNs; and imposes civil monetary penalties (up to $10,000 per violation) for non-compliance. Allows earlier appeals of LCDs once posted online.
- Extends "locum tenens" rules (temporary substitute provider arrangements) to APRNs, allowing payment for their services when substituting for absent practitioners.
- Title V: Effective Date
- Most provisions apply to services furnished 90 days after enactment; the Secretary of Health and Human Services (HHS) can implement via interim final rules or guidance. Specific sections (e.g., Shared Savings Program changes and LCD revisions) have delayed or immediate effective dates.
Significant Changes to Existing Law
- Scope of Practice Expansion: Shifts authority from physicians to APRNs for certifications, prescriptions, supervision, and referrals in Medicare and Medicaid, reducing or eliminating collaboration/supervision mandates where state law allows independent practice.
- Reimbursement Parity: Ensures APRNs receive Medicare payments comparable to physicians (e.g., 85-100% rates) and mandates Medicaid coverage for CRNA services, addressing prior exclusions.
- Regulatory Streamlining: Updates definitions and processes (e.g., LCD transparency, locum tenens) to align with modern healthcare delivery, removing outdated physician-only language in over 50 sections of the Social Security Act.
- State Law Alignment: Emphasizes deference to state regulations on APRN authority, preventing federal overrides while promoting consistency.
Potential Impacts
- On Government Agencies: HHS and the Centers for Medicare & Medicaid Services (CMS) will face implementation burdens, including rule revisions within 90 days and monitoring state compliance; could increase administrative costs short-term but reduce long-term healthcare expenditures by optimizing workforce use.
- On Citizens: Medicare and Medicaid beneficiaries (especially in rural or underserved areas) gain broader access to rehabilitation, hospice, home care, and maternity services, potentially shortening wait times and improving outcomes for chronic conditions like diabetes, heart disease, and end-of-life care. No direct international relations impacts.
- Broader Healthcare System: May alleviate physician shortages by empowering APRNs, lowering costs through efficient care delivery, and enhancing training opportunities in maternity and anesthesia.
Main Stakeholders Affected
- Advanced Practice Registered Nurses: Nurse practitioners, CRNAs, and certified nurse-midwives benefit from expanded roles, reimbursements, and reduced barriers, enabling fuller practice in various settings.
- Patients and Beneficiaries: Medicare (elderly, disabled) and Medicaid (low-income) enrollees, particularly those needing specialized care like rehabilitation or hospice.
- Healthcare Providers and Facilities: Physicians (potential collaboration shifts), hospitals, SNFs, hospices, and clinics gain flexibility in staffing; physician assistants also see indirect benefits.
- State Governments: Must align Medicaid plans with new requirements, influencing state licensure and scope-of-practice laws.
- Payers and Regulators: CMS and HHS handle enforcement; private insurers may follow suit for consistency.
Notable Legal, Constitutional, or Political Implications
- Legal: Reinforces federalism by deferring to state laws on APRN scope, potentially reducing litigation over supervision rules; introduces penalties for LCD non-compliance, strengthening accountability under the Administrative Procedure Act. Could face challenges from physician groups on patient safety or turf issues.
- Constitutional: Aligns with equal protection principles by treating qualified APRNs comparably to physicians without infringing on states' rights to regulate professions.
- Political: Supports nursing workforce advocacy amid healthcare provider shortages; bipartisan sponsorship (e.g., from both parties) highlights focus on access over ideology, but may spark debates on care quality versus cost savings in congressional committees like Energy and Commerce.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Joyce, David P. [R-OH-14]
Cosponsors (34)
Rep. Bonamici, Suzanne [D-OR-1], Rep. Kiggans, Jennifer A. [R-VA-2], Rep. Underwood, Lauren [D-IL-14], Rep. Rogers, Mike D. [R-AL-3], Rep. Smith, Adrian [R-NE-3], Rep. Grothman, Glenn [R-WI-6], Rep. Finstad, Brad [R-MN-1], Rep. McBride, Sarah [D-DE-At Large], Rep. Tlaib, Rashida [D-MI-12], Rep. Pappas, Chris [D-NH-1], Rep. Tokuda, Jill N. [D-HI-2], Rep. Hoyle, Val T. [D-OR-4], Rep. Gottheimer, Josh [D-NJ-5], Rep. Clarke, Yvette D. [D-NY-9], Rep. Hinson, Ashley [R-IA-2], Rep. Stansbury, Melanie A. [D-NM-1], Rep. Van Orden, Derrick [R-WI-3], Rep. Vasquez, Gabe [D-NM-2], Rep. Hayes, Jahana [D-CT-5], Rep. McClain Delaney, April [D-MD-6], Rep. Dingell, Debbie [D-MI-6], Rep. Randall, Emily [D-WA-6], Rep. Thompson, Bennie G. [D-MS-2], Rep. Vindman, Eugene Simon [D-VA-7], Rep. Bergman, Jack [R-MI-1], Rep. Pingree, Chellie [D-ME-1], Rep. Courtney, Joe [D-CT-2], Rep. Foster, Bill [D-IL-11], Rep. Neguse, Joe [D-CO-2], Rep. Balint, Becca [D-VT-At Large], Rep. Thompson, Glenn [R-PA-15], Rep. Thanedar, Shri [D-MI-13], Rep. Schmidt, Derek [R-KS-2], Rep. Goodlander, Maggie [D-NH-2]
Recent Actions
- 2025-02-13: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-02-13: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-02-13: Introduced in House
- 2025-02-13: Introduced in House
Bill Versions
- Improving Care and Access to Nurses Act — issued 2025-02-13 — PDF (25 pages)