Federal bill would let advanced practice nurses act independently under Medicare and Medicaid

What does this do?

The I CAN Act removes federal requirements for physician supervision or sign-off so that advanced practice registered nurses can independently perform a wider range of clinical functions under Medicare and Medicaid. Specific new authorities include nurse practitioners leading nursing home care and certifying hospice, nurse anesthetists ordering tests and referrals, and certified nurse-midwives ordering home health services and medical equipment. The bill also requires Medicare administrative contractors to disclose their evidence and consultants when making local coverage rules, and bans those contractors from restricting which licensed provider type can deliver a covered service.

Who does it affect?

Medicare and Medicaid patients — including seniors, people with disabilities, and low-income individuals — are directly affected, with the largest potential impact on patients in rural and underserved areas. Advanced practice nurses gain broader practice and payment authority, while physicians and hospitals that currently hold oversight roles over these nurses would see those roles reduced in certain settings.

Why does it matter?

Rural and underserved areas often have few physicians but a larger presence of nurse practitioners and other advanced practice nurses, so expanded independent authority could alter how and by whom care is delivered in those communities. The bill also makes CRNA services a mandatory benefit in all state Medicaid programs, which changes coverage obligations for every state.

What does it cost, and who pays?

• Fines up to $10,000 per violation
• Applies to Medicare admin contractors
• CRNA coverage required in all state Medicaid