Sponsors (33)
Introduced February 13, 2025 by David Joyce · Last progress February 13, 2025
The bill expands access and workforce capacity by broadening non‑physician clinicians' ability to order/certify services and increasing Medicaid CRNA coverage, but does so at the cost of higher federal/state spending, added administrative burdens, and risks of uneven state implementation and variable oversight.
Medicare and Medicaid beneficiaries (especially in rural and underserved areas) will have greater access to services because more non‑physician clinicians — nurse practitioners, physician assistants, clinical nurse specialists, certified nurse‑midwives, and CRNAs — can order, certify, refer, and supervise services previously limited to physicians.
Medicaid enrollees and CRNAs will benefit because CRNA ambulatory services become a mandatory Medicaid service and states must pay CRNAs at no less than Medicare‑equivalent rates, likely increasing reimbursement and availability of anesthesia care for Medicaid patients.
Medicare beneficiaries and providers will get clearer, more accountable coverage decisions because MACs must publish experts consulted and relied‑upon communications for local coverage determinations (LCDs), and providers can appeal earlier once an LCD is posted.
Taxpayers, federal and state budgets will face higher costs because expanded Medicare/Medicaid payment obligations and higher Medicaid rates (e.g., CRNA pay at Medicare‑equivalent levels) increase program spending.
Medicare and Medicaid patients could face variable quality and safety risks because expanding certifying/ordering authority to more clinician types interacts with differing state scope‑of‑practice rules and inconsistent training/oversight.
Access and implementation will vary across states because restrictive state scope‑of‑practice laws or tying CNM Medicare recognition to a single certifier can create uneven provider availability and complicate state–federal alignment.
Based on analysis of 10 sections of legislative text.
Expands non‑physician clinicians' authority and payment in Medicare and Medicaid, tightens LCD transparency with penalties, and sets most provisions to take effect 90 days after enactment.
Expands which non‑physician clinicians may order, certify, document, or be paid for specific Medicare and Medicaid services and strengthens transparency and enforcement around local coverage determinations. Key professional groups affected include nurse practitioners, physician assistants, clinical nurse specialists, certified registered nurse anesthetists (CRNAs), and certified nurse‑midwives (CNMs). Requires the Department of Health and Human Services to update rules quickly (including a 3‑month deadline for CRNA regulatory changes), mandates Medicaid coverage and payment parity for CRNA services, narrows certification recognition for midwives to a specific board, creates civil monetary penalties for Medicare contractors that fail to publish materials or impose prohibited qualifications, extends appeal timing for local coverage decisions, and generally makes most changes effective 90 days after enactment unless otherwise noted.