I CAN Act

Bill Number: S. 575
Origin Chamber: Senate
Congress: 119th Congress, Session 1
Policy Area: Health
Status: Introduced
Latest Action: 2025-02-13: Read twice and referred to the Committee on Finance.
Last Updated: 2026-06-25T12:18:23Z

AI-Generated Summary

Purpose

The "Improving Care and Access to Nurses Act" (I CAN Act), S. 575, aims to expand access to healthcare services provided by advanced practice registered nurses (APRNs)—including nurse practitioners (NPs), certified registered nurse anesthetists (CRNAs), and certified nurse-midwives (CNMs)—under Medicare (Title XVIII of the Social Security Act) and Medicaid (Title XIX). It removes certain barriers, such as supervision requirements and certification restrictions, to allow these professionals to deliver care more independently, particularly in underserved areas, while maintaining state law compliance.

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 by allowing NPs, physician assistants (PAs), or clinical nurse specialists (CNSs) to prescribe exercises and supervise sessions (previously limited to physicians).
Permits NPs and PAs 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 NPs starting in 2026.
Allows NPs, CNSs, or PAs to order medical nutrition therapy services.
Enables NPs to establish and manage home infusion therapy plans.
Authorizes NPs to certify and recertify hospice care eligibility and bill for certain non-certification services at a percentage of the physician fee schedule.
Streamlines care in skilled nursing facilities (SNFs) and nursing facilities by allowing NPs to certify post-hospital care, supervise residents, and provide services without mandatory physician collaboration (per state law).
For Medicaid, expands NP roles in certifying inpatient hospital, SNF, and intermediate care facility services; allows NPs to supervise nursing facility care.
Improves access to Medicaid clinic services by recognizing NPs as providers.

Title II: Removal of Barriers for Certified Registered Nurse Anesthetists

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 state law, with Medicare payment for those services.
Establishes special payment rules for teaching student registered nurse anesthetists, similar to physician residents.
Removes federal requirements for physician supervision of CRNAs (though state laws may still apply) and limits supervision mandates for anesthesiologist assistants.
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

Allows Medicare payments for CNM supervision of interns or residents in maternity care training.
Permits grants for clinical training projects involving CNMs.
Expands CNM authority to establish and certify Medicare home health plans.
Allows CNMs to order durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) for Medicare beneficiaries.
Updates CNM qualifications to require certification by the American Midwifery Certification Board (or successor).

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 practitioner qualification limits in LCDs; imposes civil monetary penalties (up to $10,000 per violation) for non-compliance. Allows appeals immediately upon LCD posting.
Extends "locum tenens" rules (temporary substitute provider billing) to NPs, CNSs, CRNAs, and CNMs, allowing them to bill as substitutes without reducing payments.

Title V: Effective Date

Most provisions apply to services furnished 90 days after enactment.
The Secretary of Health and Human Services (HHS) must implement via interim final rules or guidance if needed for timely compliance.
Specific sections (e.g., shared savings improvements and LCD revisions) have tailored timelines.

Significant Changes to Existing Law

Scope of Practice Expansion: Shifts from physician-only authority to include APRNs in prescribing, certifying, ordering, and supervising services (e.g., rehabilitation, hospice, home health, DMEPOS), reducing collaboration or supervision mandates where state law permits.
Reimbursement and Billing: Adds APRNs to reimbursement-eligible lists for services like nutrition therapy, hospice billing, and locum tenens; mandates Medicaid coverage for CRNA services at Medicare-equivalent rates.
Regulatory Reforms: Prohibits LCDs from restricting APRN qualifications; requires transparency in LCD development; allows CRNAs to order/refer without federal supervision barriers.
Medicaid Mandates: Makes CRNA services a required benefit; broadens NP/CN certification roles in facility admissions and supervision.
These changes build on prior laws (e.g., CARES Act flexibilities) but make many temporary provisions permanent and extend them to more APRN types.

Potential Impacts

On Citizens (Medicare/Medicaid Beneficiaries): Increases access to care, especially in rural or underserved areas with physician shortages, potentially reducing wait times for rehabilitation, hospice, maternity, anesthesia, and chronic disease management. May lower out-of-pocket costs by enabling more efficient service delivery.
On Government Agencies: HHS and Centers for Medicare & Medicaid Services (CMS) will need to update regulations, guidance, and payment systems within 90 days, possibly increasing administrative workload but aiming to cut long-term costs through APRN utilization (e.g., avoiding unnecessary physician involvement).
On Healthcare Delivery: Facilities like SNFs, hospitals, and clinics may operate more flexibly, improving staffing efficiency. No direct international relations impacts, as this is domestic health policy.
Overall, could enhance healthcare equity but might strain resources if adoption is uneven across states.

Main Stakeholders Affected

Advanced Practice Registered Nurses (APRNs): NPs, CRNAs, and CNMs benefit from expanded autonomy, reimbursement, and practice opportunities, potentially increasing their workforce participation.
Physicians and Physician Assistants: May see reduced exclusive roles in supervision and certification, though collaboration remains in some cases; PAs gain parallel expansions in select areas.
Medicare and Medicaid Beneficiaries: Elderly, low-income, disabled, and maternity patients gain broader provider options.
Healthcare Providers and Facilities: Hospitals, SNFs, nursing facilities, and clinics can leverage APRNs for cost-effective care; training programs for CNMs and student CRNAs receive support.
Government Entities: HHS/CMS for implementation; states for aligning Medicaid plans with federal mandates while respecting state laws on APRN scope.
Insurers and Payers: Medicare contractors face new transparency and penalty rules for LCDs.

Notable Legal, Constitutional, or Political Implications

Legal: Reinforces federal deference to state laws on APRN practice (e.g., supervision per state regulations), avoiding preemption conflicts. Introduces civil penalties for LCD non-compliance, enforceable under existing HHS mechanisms, which could lead to more appeals and oversight. Technical updates (e.g., CNM certification standards) standardize qualifications without altering core eligibility.
Constitutional: No apparent challenges; aligns with Congress's spending power over Medicare/Medicaid and promotes equal protection in healthcare access without infringing on states' rights.
Political: Supports bipartisan efforts (introduced by Sens. Merkley and Lummis) to address provider shortages amid aging populations and post-pandemic healthcare strains. May spark debates on APRN vs. physician roles, potentially influencing future scope-of-practice laws at state levels, but emphasizes cost savings and access over turf wars.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Sen. Merkley, Jeff [D-OR]

Cosponsors (5)

Sen. Lummis, Cynthia M. [R-WY], Sen. Coons, Christopher A. [D-DE], Sen. Welch, Peter [D-VT], Sen. Fetterman, John [D-PA], Sen. Whitehouse, Sheldon [D-RI]

Recent Actions

2025-02-13: Read twice and referred to the Committee on Finance.
2025-02-13: Introduced in Senate

Bill Versions

Improving Care and Access to Nurses Act — issued 2025-02-13 — PDF (25 pages)