I CAN Act
- Sponsor
- Rep. Joyce, David P. [R-OH-14]
- Committees
- Energy and Commerce Committee (primary)
- Last action
- Feb 13, 2025
Bottom line
The I CAN Act aims to increase patient access to healthcare services by expanding the authority and reimbursement for Advanced Practice Registered Nurses across federal health programs.
What it actually does
This bill significantly expands the scope of practice and reimbursement eligibility for Advanced Practice Registered Nurses (APRNs), including Nurse Practitioners (NPs), Certified Registered Nurse Anesthetists (CRNAs), and Certified Nurse-Midwives (CNMs), under the Medicare and Medicaid programs. It removes various federal barriers to APRN practice, allowing them to certify, order, refer, and supervise a broader range of services, and clarifies reimbursement for their services, often aligning it with physician payment schedules. The bill also revises the local coverage determination process under Medicare to prevent contractors from imposing practitioner qualifications.
Proponents argue
Proponents argue that the bill will improve access to high-quality healthcare, especially in rural and underserved areas, by allowing highly trained APRNs to practice to the full extent of their education and licensure. They contend that removing outdated federal supervision requirements and expanding reimbursement eligibility will reduce administrative burdens, lower healthcare costs, and optimize the healthcare workforce, ultimately benefiting patients by increasing provider availability and choice.
Opponents contend
Opponents, primarily physician organizations, typically express concerns that expanding the independent practice authority of APRNs without physician supervision could compromise patient safety and the quality of care. They argue that physician-led teams are essential for complex medical cases and that a lack of consistent federal oversight could lead to fragmented care or inadequate management of patient conditions, potentially increasing overall healthcare costs in the long run.
The bill is moderately complex due to its numerous technical amendments to the Social Security Act, requiring careful reading to understand the full scope of changes to Medicare and Medicaid regulations.
Sec. 101, Title I
Expanding Access to Cardiac and Pulmonary Rehabilitation Programs
This section amends the Social Security Act to allow nurse practitioners, physician assistants, and clinical nurse specialists to prescribe and supervise cardiac and pulmonary rehabilitation programs under Medicare. Previously, these programs required physician involvement for prescription and supervision. This change broadens the pool of eligible healthcare professionals who can initiate and oversee these critical rehabilitation services.
Supporters argue
Proponents argue that this provision will significantly improve access to vital cardiac and pulmonary rehabilitation services, especially in areas with physician shortages. They contend that APRNs and PAs are fully qualified to manage these programs, and their inclusion will reduce delays in care and improve patient outcomes.
Critics contend
Some physician groups might argue that while beneficial, complex rehabilitation plans should ideally remain under direct physician oversight to ensure comprehensive care coordination and address potential complications, even if APRNs are involved in day-to-day supervision.
Tradeoffs
The provision balances the need for increased patient access to rehabilitation services against traditional models of physician-led care, aiming to leverage the full capabilities of APRNs and PAs.
Sec. 106, Title I
Increasing Access to Hospice Care Services
This section amends Medicare provisions to allow nurse practitioners to certify and recertify eligibility for hospice care, and to bill for services not typically covered under the hospice per diem rate, similar to physicians. It also updates the definition of hospice care to include services ordered by a nurse practitioner. This change streamlines the process for patients to access hospice benefits and expands the types of providers who can manage hospice care.
Sec. 107, Title I
Streamlining Care in Skilled Nursing Facilities and Hospitals
This section authorizes nurse practitioners to certify post-hospital extended care services, provide supervision in skilled nursing facilities (SNFs), and serve as the attending provider for Medicare and Medicaid inpatient hospital patients. It removes the requirement for nurse practitioners to work in collaboration with a physician for certain services in SNFs and hospitals, granting them greater autonomy in these settings, consistent with state law. This aims to improve efficiency and access to care in institutional settings.
Sec. 204, Title II
Removing Unnecessary and Costly Supervision of Certified Registered Nurse Anesthetists
This section amends the Social Security Act to explicitly state that Medicare may not require Certified Registered Nurse Anesthetists (CRNAs) to provide services under the supervision of a physician. It clarifies that while conditions for payment may include state certification of CRNAs, federal law cannot mandate physician supervision. This change grants CRNAs full practice authority at the federal level, aligning with many state laws.
Sec. 205, Title II
CRNA Services as a Medicaid-Required Benefit and Payment Parity
This section mandates that services furnished by Certified Registered Nurse Anesthetists (CRNAs) be a required benefit under state Medicaid plans, provided the CRNA is authorized to perform such services under state law. Furthermore, it requires that Medicaid payment for CRNA services be no lower than the amounts, using the same methodology, used for payment under Medicare Part B. This ensures CRNA services are consistently covered and fairly reimbursed across states participating in Medicaid.
Sec. 302, Title III
Improving Medicare Patient Access to Home Health Services Provided by Certified Nurse-Midwives
This section amends Medicare provisions to allow Certified Nurse-Midwives (CNMs) to order home health services for Medicare beneficiaries. Previously, home health services typically required a physician's order. This change expands the types of qualified healthcare professionals who can initiate home health care plans, particularly benefiting pregnant and postpartum individuals and those with gynecological needs.
Sec. 401, Title IV
Revising the Local Coverage Determination (LCD) Process
This section amends the Medicare program to prohibit Medicare Administrative Contractors (MACs) from imposing practitioner qualifications in Local Coverage Determinations (LCDs) for items or services. It also increases transparency requirements for LCDs, mandating MACs to identify experts consulted, hyperlink to relied-upon communications and criteria, and imposes a civil monetary penalty of up to $10,000 for non-compliance. This aims to prevent MACs from creating barriers to APRN practice through coverage policies.
Prohibits Medicare Administrative Contractors (MACs) from imposing coverage limitations on the qualifications of physicians or practitioners (including APRNs) who may furnish an item or service that is the subject of a local coverage determination (LCD).
Sec. 401(a)(2)(E)
Why it matters:This is likely standard legislative practice for amending existing regulatory processes, but its impact on APRN scope is significant and could be missed by a reader not deeply familiar with Medicare administrative procedures.
Case for: Supporters argue this prevents MACs from creating de facto scope-of-practice restrictions that override state laws and federal intent, ensuring that qualified APRNs can provide covered services without arbitrary barriers.
Case against: MACs might argue that they need the ability to define appropriate provider qualifications for certain complex services to ensure quality and prevent fraud, waste, and abuse, and that this restriction limits their ability to manage program integrity effectively.
Estimated impact: Significantly expands and protects the practice authority of APRNs by preventing federal contractors from imposing additional, non-statutory restrictions on who can provide Medicare-covered services.
Establishes a civil monetary penalty of not more than $10,000 for Medicare Administrative Contractors (MACs) that fail to make required information available for LCDs or fail to comply with the prohibition on imposing practitioner qualifications.
Sec. 401(a)(2)(F)
Why it matters:This is a standard legislative technique to add teeth to new requirements, ensuring compliance through financial penalties. It's not necessarily evasive but could be overlooked as a procedural detail.
Case for: Proponents argue that penalties are necessary to ensure MACs comply with the new transparency and non-discrimination requirements, preventing them from circumventing the intent of the law.
Case against: MACs might argue that such penalties are overly punitive for administrative errors or disagreements over interpretation, potentially leading to a chilling effect on their ability to make timely coverage decisions.
Estimated impact: Creates a strong incentive for MACs to comply with the new LCD transparency and practitioner qualification rules, potentially leading to more consistent and equitable coverage policies.
Establishes a general effective date for most provisions of the Act as 90 days after enactment and authorizes the Secretary of Health and Human Services to implement these provisions through interim final rule or subregulatory guidance if necessary to meet the effective date.
Sec. 501, Title V
Why it matters:The effective date is a standard closing provision. The authorization for interim final rule is a common mechanism to expedite implementation of complex legislative changes, particularly when there's a tight deadline, but it bypasses the full public notice-and-comment rulemaking process.
Case for: Proponents argue that allowing interim final rules or subregulatory guidance is crucial for rapid implementation of these vital changes, ensuring that patients and providers can benefit from expanded access and reduced burdens without undue delay.
Case against: Critics of interim final rules often argue that they reduce transparency and public input, potentially leading to unintended consequences or policies that do not fully reflect stakeholder concerns, as the full rulemaking process is bypassed.
Estimated impact: Enables swift implementation of the bill's provisions, potentially accelerating the expansion of APRN practice and access to care, but with reduced public input on the specific regulatory details.