Sponsors (32)
Introduced February 13, 2025 by David Joyce · Last progress February 13, 2025
The bill broadens which non‑physician clinicians can certify, order, and be paid for Medicare/Medicaid services—improving access and workforce capacity and increasing transparency—at the cost of higher federal/state spending, implementation and administrative strain, and potential quality and state‑by‑state variability risks.
Medicare and Medicaid beneficiaries (and people in rural/underserved areas) gain greater access to covered services because nurse practitioners, physician assistants, clinical nurse specialists, certified registered nurse anesthetists (CRNAs), and certified nurse‑midwives (CNMs) can order/certify/prescribe or be paid for services previously limited to physicians.
The bill supports workforce capacity and training (e.g., HRSA grant use for CNM clinical training and recognition of CRNA teaching/student payment), which should help grow maternity, anesthesia, and other provider supply, especially in underserved areas.
Medicare administrative transparency is increased because MACs must publish experts consulted and relied‑upon communications/guidelines for Local Coverage Determinations (LCDs), and providers may appeal LCDs earlier (upon posting), improving accountability and earlier recourse for providers and beneficiaries.
Taxpayers and state budgets face increased costs because the bill expands Medicare/Medicaid payment obligations (including making CRNA services mandatory for Medicaid and requiring Medicaid rates at Medicare‑equivalent amounts) and could increase service utilization.
The accelerated implementation timelines and short rulemaking deadlines (including a 3‑month HHS deadline and a 90‑day effective date) plus new MAC publication/penalty rules create substantial administrative and compliance burdens and raise the risk of rushed, unclear regulatory guidance during rollout.
Expanding authority to non‑physician clinicians may create variable quality-of-care and oversight concerns because training, supervision, and scope‑of‑practice differ by clinician type and state, producing uneven patient protection and access across states.
Based on analysis of 10 sections of legislative text.
Expands which non-physician clinicians can prescribe, order, certify, or document Medicare/Medicaid services, requires Medicaid coverage/payment for CRNAs, tightens contractor transparency, and sets a 90-day effective date.
Expands which non-physician clinicians can prescribe, certify, order, or document services for Medicare and Medicaid; requires Medicaid coverage and a Medicare-based payment floor for certified registered nurse anesthetist (CRNA) services; adds certified nurse‑midwives into multiple Medicare rules and grants eligibility; tightens transparency and appeal rules for local coverage determinations and adds penalties for contractors that fail to comply. Most changes take effect 90 days after enactment, with some deadlines for agency rulemaking and a change to ACO beneficiary assignment beginning in 2026.