Summary

Expands who may order, certify, bill for, and furnish many Medicare and Medicaid services by broadening the roles of nurse practitioners, certified registered nurse anesthetists (CRNAs), and certified nurse‑midwives (CNMs). It also requires faster regulatory action by HHS on selected payment rules, instructs Medicaid to cover CRNA services under a specific payment method, and tightens transparency and limits on how Medicare contractors set local coverage rules. Requires most changes to take effect for items and services furnished on or after 90 days after enactment, and directs HHS to use interim final rules or subregulatory guidance if necessary to meet those effective dates.

Key Points

• Allows NPs (and in some cases PAs and CNSs) to perform and bill for more Medicare/Medicaid services previously limited to physicians.
• Removes statutory/payment barriers for CRNAs and requires HHS to revise Medicare payment rules within three months.
• Expands CNM authority for maternity, home health, and DME services and updates certification requirements.
• Requires Medicare contractors to disclose experts, communications, and relied-upon rules when issuing local coverage determinations.
• Bans contractor coverage limits that disqualify statutory providers based solely on practitioner qualifications and creates enforcement (civil penalty) and complaint mechanisms.
• Most changes take effect for items/services furnished on or after 90 days after enactment; HHS may use interim final rules or guidance to meet that timeline.
• Directs Medicaid to cover and pay for CRNA services under a specified payment methodology.
• Imposes targeted technical edits to align Social Security Act language (including locum tenens and certification wording).

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