Sponsors (31)
The bill broadens which clinicians can order, certify, and bill for Medicare/Medicaid services—improving access and workforce flexibility for many patients—while raising federal/state costs, creating uneven state-by-state effects, and posing implementation and oversight challenges.
Medicare beneficiaries (seniors, pregnant people, those needing home health/hospice/infusion/anesthesia) will have increased access to care because more clinician types (NPs, PAs, CNSs, CNMs, CRNAs) can certify, order, supervise, or bill for services.
Frontline clinicians (CRNAs, NPs, CNMs, PAs, CNSs) and hospitals will see expanded payment/reimbursement opportunities (including parity for locum tenens and potential higher CRNA pay), which can sustain workforce capacity and access in underserved areas.
Accountable Care Organizations (and their patients) may get better care coordination and attribution because primary care services furnished by additional ACO professionals will count for beneficiary assignment beginning in 2026.
Taxpayers and federal/state budgets may face higher costs because expanding who can bill/order Medicare and aligning CRNA/other payments can increase Medicare and Medicaid spending.
Patients' access gains will be uneven because state scope-of-practice laws and a narrowed CNM certification pathway mean benefits differ by state and some providers may be excluded from Medicare eligibility.
Quality and oversight risks may increase if SNF supervisory requirements shift and non‑employee PAs/CNSs or reduced physician involvement become more common, potentially creating uneven supervision in facilities.
Based on analysis of 10 sections of legislative text.
Broadens which advanced practice clinicians may order, furnish, and be paid for certain Medicare and Medicaid services, increases LCD transparency and penalties, and updates ACO assignment rules.
Introduced February 13, 2025 by David Joyce · Last progress February 13, 2025
Expands which advanced practice clinicians (nurse practitioners, physician assistants, clinical nurse specialists, certified nurse‑midwives, and certified registered nurse anesthetists) may order, certify, furnish, or be paid for a range of Medicare and Medicaid services, and changes certain Medicare Shared Savings Program beneficiary assignment rules. It also increases transparency and limits contractor-imposed practitioner qualification requirements for local coverage determinations, creates penalties for noncompliant contractors, and allows HHS to use interim rules or guidance to implement many changes quickly. The changes affect coverage and billing rules for cardiac and pulmonary rehabilitation, therapeutic shoes for diabetes, medical nutrition therapy, home infusion therapy, CRNA services in Medicare and Medicaid, nurse‑midwife scope and certification, and locum tenens flexibility for advanced practice clinicians. Most provisions take effect for items and services furnished 90 days after enactment, with some changes phased in for performance years beginning on or after January 1, 2026, and HHS authorized to issue interim guidance or rules to meet timing requirements.