[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1317 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 1317
To amend titles XVIII and XIX of the Social Security Act to increase
access to services provided by advanced practice registered nurses
under the Medicare and Medicaid programs, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 13, 2025
Mr. Joyce of Ohio (for himself, Ms. Bonamici, Mrs. Kiggans of Virginia,
Ms. Underwood, and Mr. Rogers of Alabama) introduced the following
bill; which was 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
_______________________________________________________________________
A BILL
To amend titles XVIII and XIX of the Social Security Act to increase
access to services provided by advanced practice registered nurses
under the Medicare and Medicaid programs, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Improving Care and
Access to Nurses Act'' or the ``I CAN Act''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--REMOVAL OF BARRIERS TO PRACTICE ON NURSE PRACTITIONERS
Sec. 101. Expanding access to cardiac rehabilitation programs and
pulmonary rehabilitation programs under
Medicare program.
Sec. 102. Permitting nurse practitioners and physician assistants to
satisfy Medicare documentation requirement
for coverage of certain shoes for
individuals with diabetes.
Sec. 103. Improvements to the assignment of beneficiaries under the
Medicare shared savings program.
Sec. 104. Expanding the availability of medical nutrition therapy
service Medicare program.
Sec. 105. Preserving access to home infusion therapy.
Sec. 106. Increasing access to hospice care services.
Sec. 107. Streamlining care delivery in skilled nursing facilities and
nursing facilities; authorizing Medicare
and Medicaid inpatient hospital patients to
be under the care of a nurse practitioner.
Sec. 108. Improving access to Medicaid clinic services.
TITLE II--REMOVAL OF BARRIERS TO PRACTICE ON CERTIFIED REGISTERED NURSE
ANESTHETISTS
Sec. 201. Clarifying that certified registered nurse anesthetists can
be reimbursed by Medicare for evaluation
and management services.
Sec. 202. Revision of conditions of payment relating to services
ordered and referred by certified
registered nurse anesthetists.
Sec. 203. Special payment rule for teaching student registered nurse
anesthetists.
Sec. 204. Removing unnecessary and costly supervision of certified
registered nurse anesthetists.
Sec. 205. CRNA services as a Medicaid-required benefit.
TITLE III--REMOVAL OF BARRIERS TO PRACTICE ON CERTIFIED NURSE-MIDWIVES
Sec. 301. Improving access to training in maternity care.
Sec. 302. Improving Medicare patient access to home health services
provided by certified nurse-midwives.
Sec. 303. Improving access to DMEPOS for Medicare beneficiaries.
Sec. 304. Technical changes to qualifications and conditions with
respect to the services of certified nurse-
midwives.
TITLE IV--IMPROVING FEDERAL HEALTH PROGRAMS FOR ALL ADVANCED PRACTICE
REGISTERED NURSES
Sec. 401. Revising the local coverage determination process under the
Medicare program.
Sec. 402. Locum tenens.
TITLE V--EFFECTIVE DATE
Sec. 501. Effective date.
TITLE I--REMOVAL OF BARRIERS TO PRACTICE ON NURSE PRACTITIONERS
SEC. 101. EXPANDING ACCESS TO CARDIAC REHABILITATION PROGRAMS AND
PULMONARY REHABILITATION PROGRAMS UNDER MEDICARE PROGRAM.
(a) Cardiac Rehabilitation Programs.--Section 1861(eee) of the
Social Security Act (42 U.S.C. 1395x(eee)) is amended--
(1) in paragraph (2)--
(A) in subparagraph (A)(i), by striking ``a
physician's office'' and inserting ``the office
setting''; and
(B) in subparagraph (C), by inserting after
``physician'' the following: ``(as defined in
subsection (r)(1)) or a physician assistant, nurse
practitioner, or clinical nurse specialist (as those
terms are defined in subsection (aa)(5))'';
(2) in paragraph (3)(A), by striking ``physician-prescribed
exercise'' and inserting ``exercise prescribed by a physician
(as defined in subsection (r)(1)) or a physician assistant,
nurse practitioner, or clinical nurse specialist (as those
terms are defined in subsection (aa)(5))''; and
(3) in paragraph (5), by inserting after ``physician'' the
following: ``(as defined in subsection (r)(1)) or a physician
assistant, nurse practitioner, or clinical nurse specialist (as
those terms are defined in subsection (aa)(5))''.
(b) Pulmonary Rehabilitation Programs.--Section 1861(fff) of the
Social Security Act (42 U.S.C. 1395x(fff)) is amended--
(1) in paragraph (2)(A), by striking ``physician-prescribed
exercise'' and inserting ``exercise prescribed by a physician
(as defined in subsection (r)(1)) or a physician assistant,
nurse practitioner, or clinical nurse specialist (as those
terms are defined in subsection (aa)(5))''; and
(2) in paragraph (3), by inserting after ``physician'' the
following: ``(as defined in subsection (r)(1)) or a physician
assistant, nurse practitioner, or clinical nurse specialist (as
those terms are defined in subsection (aa)(5))''.
SEC. 102. PERMITTING NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS TO
SATISFY MEDICARE DOCUMENTATION REQUIREMENT FOR COVERAGE
OF CERTAIN SHOES FOR INDIVIDUALS WITH DIABETES.
Section 1861(s)(12) of the Social Security Act (42 U.S.C.
1395x(s)(12)) is amended--
(1) in subparagraph (A), by inserting ``, nurse
practitioner, or physician assistant'' after ``physician''; and
(2) in subparagraph (C), by inserting ``, nurse
practitioner, or physician assistant'' after each occurrence of
``physician''.
SEC. 103. IMPROVEMENTS TO THE ASSIGNMENT OF BENEFICIARIES UNDER THE
MEDICARE SHARED SAVINGS PROGRAM.
Section 1899(c)(1) of the Social Security Act (42 U.S.C.
1395jjj(c)(1)) is amended--
(1) in subparagraph (A), by striking ``and'' at the end;
(2) in subparagraph (B), by striking the period at the end
and inserting ``; and''; and
(3) by adding at the end the following new subparagraph:
``(C) in the case of performance years beginning on
or after January 1, 2026, primary care services
provided under this title by an ACO professional
described in subsection (h)(1)(B).''.
SEC. 104. EXPANDING THE AVAILABILITY OF MEDICAL NUTRITION THERAPY
SERVICE MEDICARE PROGRAM.
Section 1861(vv)(1) of the Social Security Act (42 U.S.C.
1395x(vv)(1)) is amended by inserting `` or a nurse practitioner, a
clinical nurse specialist, or a physician assistant (as such terms are
defined in subsection (aa)(5))'' before the period at the end.
SEC. 105. PRESERVING ACCESS TO HOME INFUSION THERAPY.
(a) Allowing Applicable Providers To Establish Home Infusion
Therapy Plans.--Section 1861(iii)(1)(B) of the Social Security Act (42
U.S.C. 1395x(iii)(1)(B)) is amended--
(1) by striking ``a physician (as defined in subsection
(r)(1))'' and inserting ``an applicable provider (as defined in
paragraph (3)(A))''; and
(2) by striking ``a physician (as so defined)'' and
inserting ``an applicable provider (as so defined)''.
(b) Conforming Amendment.--Section 1834(u)(6) of the Social
Security Act (42 U.S.C. 1395m(u)(6)) is amended by striking
``physician'' and inserting ``applicable provider (as defined in
section 1861(iii)(3)(A))''.
SEC. 106. INCREASING ACCESS TO HOSPICE CARE SERVICES.
(a) In General.--Section 1814(a)(7)(A) of the Social Security Act
(42 U.S.C. 1395f(a)(7)(A)) is amended--
(1) in clause (i)--
(A) in subclause (I), by striking ``a nurse
practitioner or'';
(B) in subclause (II), by inserting ``or nurse
practitioner'' after ``physician''; and
(C) in the flush matter following subclause (II),
by inserting ``, nurse practitioner's,'' after
``physician's''; and
(2) in clause (ii), by striking ``or physician'' and
inserting ``, physician, or nurse practitioner''.
(b) Hospice Care Definition.--Section 1861(dd)(1)(C) of the Social
Security Act (42 U.S.C. 1395x(dd)(1)(C)) is amended by inserting ``or
nurse practitioner'' after ``physician''.
(c) Nurse Practitioner Billing.--Not later than 90 days after the
date of the enactment of this Act, the Secretary of Health and Human
Services shall revise section 418.304 of title 42, Code of Federal
Regulations, to allow nurse practitioners to bill for services not
described in paragraph (a) of such section in the same manner as
physicians may bill for such services in accordance with paragraph (b)
of such section. Such revision shall provide that such services
furnished by a nurse practitioner shall be payable at the percent of
the physician fee schedule specified in section 1833(a)(1)(O) of the
Social Security Act (42 U.S.C. 1395l(a)(1)(O)).
SEC. 107. STREAMLINING CARE DELIVERY IN SKILLED NURSING FACILITIES AND
NURSING FACILITIES; AUTHORIZING MEDICARE AND MEDICAID
INPATIENT HOSPITAL PATIENTS TO BE UNDER THE CARE OF A
NURSE PRACTITIONER.
(a) Medicare.--
(1) Certification of post-hospital extended care
services.--Section 1814(a)(2) of the Social Security Act (42
U.S.C. 1395f(a)(2)) is amended, in the matter preceding
subparagraph (A), by striking ``, or a nurse practitioner,''
and inserting ``or a nurse practitioner (in accordance with
State law), or''.
(2) Certification authority for nurse practitioners.--
Section 1814(a)(3) of the Social Security Act (42 U.S.C.
1395f(a)(3)) is amended by inserting ``or nurse practitioner''
after ``physician''.
(3) Supervision requirement in skilled nursing facility
services and resident's rights.--Section 1819 of the Social
Security Act (42 U.S.C. 1395i-3(b)(6)) is amended--
(A) in subsection (b)--
(i) in paragraph (2)(B), by inserting ``or
nurse practitioner'' after ``attending
physician''; and
(ii) in paragraph (6)--
(I) in the heading, by striking
``Physician supervision'' and inserting
``Supervision''; and
(II) in subparagraph (A), by
inserting ``or a nurse practitioner, in
accordance with State law'' after
``physician''; and
(B) in subsection (c)--
(i) in subparagraph (1)(A)(i), by inserting
``or nurse practitioner'' after ``attending
physician'';
(ii) in the flush matter at the end of
subparagraph (2)(A), by inserting ``or nurse
practitioner'' after ``physician'' in each
occurrence; and
(iii) in subparagraph (3)(A), by inserting
``or nurse practitioner'' after ``physician''.
(4) Administration of part b.--Section 1842(b)(2)(C) of the
Social Security Act (42 U.S.C. 1395u(b)(2)(C)) is amended, in
the second sentence--
(A) by inserting ``or a nurse practitioner'' after
``a physician''; and
(B) by striking ``or a nurse practitioner working
in collaboration with that physician, or both''.
(5) Provision of medical and other health services.--
Section 1861(s)(2)(K)(ii) of the Social Security Act (42 U.S.C.
1395x(s)(2)(K)(ii)) is amended by striking ``or clinical nurse
specialist (as defined in subsection (aa)(5)) working in
collaboration (as defined in subsection (aa)(6)) with a
physician (as defined in subsection (r)(1))'' and inserting
``(as defined in subsection (aa)(5)(A)), or by a clinical nurse
specialist (as defined in subsection (aa)(5)(B)) working in
collaboration with a physician (as defined in subsection
(r)(1)),''.
(6) Privileges for nurse practitioners.--Section 1861 of
the Social Security Act (42 U.S.C. 1395x) is amended--
(A) in subsection (e)(4), by inserting ``(or nurse
practitioner, in accordance with State law)'' after
``physician'';
(B) in subsection (f)(1), by inserting ``or nurse
practitioner'' after ``physician''; and
(C) in each of subparagraphs (B) and (F) of
subsection (ee)(2), by inserting ``or nurse
practitioner'' after ``physician''.
(b) Medicaid.--
(1) Certification authority for nurse practitioners.--
Section 1902(a)(44) of the Social Security Act (42 U.S.C.
1396a(a)(44)) is amended to read as follows:
``(44) in each case for which payment for inpatient
hospital services, skilled nursing facility services, services
in an intermediate care facility described in section 1905(d),
or inpatient mental hospital services is made under the State
plan--
``(A) a physician or nurse practitioner (or, in the
case of skilled nursing facility services or
intermediate care facility services, a physician or
nurse practitioner, or a clinical nurse specialist who
is not an employee of the facility but is working in
collaboration with a physician) certifies at the time
of admission, or, if later, the time the individual
applies for medical assistance under the State plan
(and a physician or nurse practitioner, or a physician
assistant under the supervision of a physician, or, in
the case of skilled nursing facility services or
intermediate care facility services, a physician or
nurse practitioner, or a clinical nurse specialist who
is not an employee of the facility but is working in
collaboration with a physician, recertifies, where such
services are furnished over a period of time, in such
cases, at least as often as required under section
1903(g)(6) (or, in the case of services that are
services provided in an intermediate care facility,
every year), and accompanied by such supporting
material, appropriate to the case involved, as may be
provided in regulations of the Secretary), that such
services are or were required to be given on an
inpatient basis because the individual needs or needed
such services, and
``(B) such services were furnished under a plan
established and periodically reviewed and evaluated by
a physician or nurse practitioner, or, in the case of
skilled nursing facility services or intermediate care
facility services, by a physician or nurse
practitioner, or a clinical nurse specialist who is not
an employee of the facility but is working in
collaboration with a physician;''.
(2) Nursing facility services supervision and clinical
records.--Section 1919(b)(6)(A) of the Social Security Act (42
U.S.C. 1396r(b)(6)(A)) is amended to read as follows:
``(A) require that the health care of every
resident be provided under the supervision of a
physician or nurse practitioner (or, at the option of a
State, under the supervision of a clinical nurse
specialist or physician assistant who is not an
employee of the facility but who is working in
collaboration with a physician);''.
SEC. 108. IMPROVING ACCESS TO MEDICAID CLINIC SERVICES.
Section 1905(a)(9) of the Social Security Act (42 U.S.C.
1396d(a)(9)) is amended by adding ``or nurse practitioner'' after
``physician'' in both places that it appears.
TITLE II--REMOVAL OF BARRIERS TO PRACTICE ON CERTIFIED REGISTERED NURSE
ANESTHETISTS
SEC. 201. CLARIFYING THAT CERTIFIED REGISTERED NURSE ANESTHETISTS CAN
BE REIMBURSED BY MEDICARE FOR EVALUATION AND MANAGEMENT
SERVICES.
Section 1861(bb)(1) of the Social Security Act (42 U.S.C.
1395x(bb)(1)) is amended by inserting ``, including pre-anesthesia
evaluation and management services,'' after ``and related care''.
SEC. 202. REVISION OF CONDITIONS OF PAYMENT RELATING TO SERVICES
ORDERED AND REFERRED BY CERTIFIED REGISTERED NURSE
ANESTHETISTS.
Not later than 3 months after the date of enactment of this Act,
the Secretary of Health and Human Services shall revise section 410.69
of title 42, Code of Federal Regulations, to clarify that, for purposes
of payment under part B of title XVIII of the Social Security Act--
(1) certified registered nurse anesthetists are authorized
to order, certify, and refer services to the extent allowed
under the law of the State in which the services are furnished;
and
(2) payment shall be made under such part for such services
so ordered, certified, or referred by certified registered
nurse anesthetists.
SEC. 203. SPECIAL PAYMENT RULE FOR TEACHING STUDENT REGISTERED NURSE
ANESTHETISTS.
Section 1848(a)(6) of the Social