Sponsors (37)
The bill expands non‑physician clinicians' authority and increases transparency to improve access and accountability for Medicare and Medicaid patients—especially in underserved areas—at the cost of higher federal/state spending, implementation and administrative burdens, and potential variability in care quality and state-by-state access.
Medicare and Medicaid beneficiaries — especially in rural and underserved areas — will have expanded access to care because nurse practitioners, physician assistants, clinical nurse specialists, CRNAs, and certified nurse‑midwives can order/certify/refer for more services (rehab, home infusion, nutrition therapy, anesthesia, maternity care).
Clinician workforce capacity and compensation are supported by program changes (Medicaid payment floor for CRNAs to Medicare-equivalent rates, recognition of CRNA E/M and teaching payments, and HRSA grant use for CNM training), which can boost provider supply and incomes.
Medicare beneficiaries and providers gain greater transparency and ability to challenge local coverage determinations (MACs must publish consulted experts and relied-upon materials; appeals can be filed once an LCD is posted; locum tenens parity for nonphysician practitioners), improving accountability and earlier dispute resolution.
Medicare and Medicaid patients risk variable quality of care and uneven access because expanded authority for non‑physician clinicians interacts with differing state scope‑of‑practice rules and variable training, potentially creating safety concerns and interstate disparities.
Federal and state budgets (and ultimately taxpayers) face higher costs because Medicare/Medicaid payment obligations expand, Medicaid rates for CRNAs are required at Medicare-equivalent levels, and broader clinician authority could increase utilization.
Hospitals, providers, states, CMS and MACs will face notable administrative and compliance burdens from multiple implementation deadlines (including a 90‑day effective date and short HHS rulemaking timelines), rule changes for hospice/SNF supervision, MAC publication requirements, and possible penalties, increasing transitional costs and operational strain.
Based on analysis of 10 sections of legislative text.
Expands authority and payment recognition for advanced practice clinicians in Medicare and Medicaid, requires MAC transparency for LCDs, and makes CRNA services mandatory in Medicaid with payment parity rules.
Official title: To amend titles XVIII and XIX of the Social Security Act to increase access to services provided by advanced practice registered nurses under the Medicare and Medicaid programs, and for other purposes.
Introduced February 13, 2025 by David Joyce · Last progress February 13, 2025
This bill expands which non-physician clinicians may prescribe, certify, order, document, or be paid for certain Medicare and Medicaid services. It adds nurse practitioners, physician assistants, clinical nurse specialists, certified nurse‑midwives, and certified registered nurse anesthetists (CRNAs) into multiple Medicare/Medicaid coverage, payment, ordering, and assignment rules and requires HHS rulemaking and publication requirements for local coverage determinations. The bill also increases transparency and appeal timing for Medicare contractor local coverage determinations, creates civil monetary penalties for contractor noncompliance, extends locum tenens parity to advanced practice clinicians, and sets a general effective date of 90 days after enactment (with limited exceptions and interim rule authority for HHS).