Sponsors (36)
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
The bill broadens which non‑physician clinicians can order, certify, and be paid for Medicare/Medicaid services—improving access and workforce capacity (especially in underserved areas) and increasing transparency—while raising program costs, creating implementation and administrative burdens, and producing potential quality, state‑level equity, and stakeholder‑input concerns.
Medicare and Medicaid beneficiaries will gain broader access to covered services because nurse practitioners, physician assistants, clinical nurse specialists, certified nurse‑midwives, and CRNAs can order/certify/refer and establish care plans for more treatments (cardiac/pulmonary rehab, therapeutic shoes, home infusion, medical nutrition therapy, DMEPOS, home health).
Medicaid enrollees and CRNAs will benefit from required Medicaid coverage of CRNA services and payment parity (no less than Medicare-equivalent), likely increasing availability of anesthesia care for low‑income patients and improving CRNA reimbursement.
Expanding who can furnish, supervise, and be paid for services (including reduced supervision for CRNAs, E/M and teaching-student payment, and broader authority for NPs/PAs/CNSs) increases workforce capacity and access in underserved and rural areas.
Federal and state spending will likely increase because Medicare/Medicaid payment obligations expand and Medicaid is required to pay CRNAs at Medicare‑equivalent rates, raising program costs and taxpayer exposure.
Broadening which clinicians can certify, order, or supervise care raises quality and safety concerns due to variable training, differing state scope‑of‑practice rules, and potential uneven supervision, creating risks for incorrect orders or inconsistent care.
Providers, states, and CMS will face meaningful administrative, compliance, and IT costs and burdens—updating enrollment/claims systems, changing supervisory rules, responding to shortened rulemaking timelines, and complying with new MAC publication/appeal processes.
Based on analysis of 10 sections of legislative text.
Expands which non‑physician clinicians can order/certify/document Medicare services, requires Medicaid coverage/payment parity for CRNAs, and increases MAC LCD transparency and penalties.
Allows a wider range of non‑physician clinicians (nurse practitioners, physician assistants, clinical nurse specialists, certified nurse‑midwives, and certified registered nurse anesthetists) to perform, certify, order, or document specific Medicare‑covered services that previously required physicians. It also requires Medicaid plans to cover and pay CRNA services at rates no less than Medicare, tightens rules on who can certify midwifery credentials, increases transparency and limits contractor‑imposed practitioner qualifications for local coverage decisions, and creates penalties for noncompliant Medicare administrative contractors. Most changes take effect 90 days after enactment (with specified exceptions) and include a 3‑month HHS rulemaking deadline for CRNA ordering/coverage rules; HHS may use interim final rules or guidance to meet effective dates. The bill shifts who may deliver or authorize care, changes ACO beneficiary assignment rules beginning in 2026, and creates enforcement tools for Medicare contractors that fail to publish required materials or impose prohibited qualifications.