I CAN Act

This bill, the Improving Care and Access to Nurses Act, makes it easier for people on Medicare and Medicaid to get care from advanced practice nurses. It lets nurse practitioners, physician assistants, and clinical nurse specialists prescribe and oversee cardiac and lung rehab, and allows nurse practitioners or physician assistants to handle the paperwork for special shoes for people with diabetes. It expands access to nutrition therapy, protects home infusion therapy by letting qualified non‑physician providers set up care plans, and improves hospice access by allowing nurse practitioners to certify and bill for more services . It also increases the roles of certified nurse anesthetists and certified nurse‑midwives across Medicare and Medicaid so patients can get timely care from more types of trained providers .

The bill streamlines care in hospitals and nursing facilities by allowing nurse practitioners to certify and manage care under Medicare and Medicaid, and it adds nurse practitioners to Medicaid clinic services . For nurse anesthetists, it clarifies Medicare payment for evaluation and management services, lets them order and refer care when state law allows, reduces unnecessary supervision, and makes their services a required Medicaid benefit with payment protections . For nurse‑midwives, it supports training, lets them certify home health, and expands who can order medical equipment for Medicare patients. It also makes local Medicare coverage rules more transparent and bars contractors from limiting which qualified providers can deliver covered services. Most changes start 90 days after the law is signed; a change to how Medicare assigns patients in its shared‑savings program begins in 2026 .

• Who is affected: People on Medicare and Medicaid; nurse practitioners, clinical nurse specialists, certified nurse‑midwives, certified nurse anesthetists; and physician assistants in certain tasks .
• Care that gets easier to access: cardiac and pulmonary rehab; nutrition therapy; home infusion; hospice services .
• Settings impacted: hospitals, skilled nursing facilities, nursing facilities, and Medicaid clinics (adds nurse practitioners) .
• Nurse anesthetists: clearer Medicare pay for visit‑type services; authority to order/refer; less supervision; recognized Medicaid benefit with payment protections .
• Nurse‑midwives: more support for training; can sign home health orders; can order needed medical equipment for patients on Medicare.
• When: Most provisions take effect 90 days after enactment; CRNA ordering/referral rules must be updated within 3 months; hospice billing changes for nurse practitioners within 90 days; patient assignment change in 2026 .