Sponsors (6)
The bill expands access to care by empowering non‑physician clinicians and speeding implementation of coverage/payment changes—likely improving timely services and provider participation—but does so at the cost of higher federal/state spending, added administrative burdens, and potential variability or unevenness in quality and state-by-state access.
Medicare and Medicaid beneficiaries (and other patients needing routine or specialty services) will have increased access to care because nurse practitioners, physician assistants, clinical nurse specialists, CRNAs, and certified nurse‑midwives can provide, document, and certify more Medicare/Medicaid-covered services.
Hospice providers, CRNAs, CNMs and other non‑physician clinicians will receive clearer billing parity or higher reimbursement (e.g., NP hospice billing at physician-fee-schedule percentage; CRNA E/M reimbursement; Medicaid CRNA payment floor), which should improve provider participation and access for beneficiaries.
Patients served by accountable care organizations (ACOs) may benefit from improved care coordination because ACO assignment rules will count primary care furnished by additional ACO professionals, potentially increasing beneficiary assignment to ACOs.
Taxpayers and federal/state budgets may face higher Medicare and Medicaid spending because expanded provider authority and new payment parity/billing rules are likely to increase billable services and higher reimbursement rates.
Medicare and Medicaid patients could experience variable care quality because broader clinician documentation, prescribing, ordering, and supervisory authorities depend on differing training, supervision, and state scope‑of‑practice rules.
State governments and Medicaid programs may face material budget pressure because states are required to pay CRNA services at or above Medicare rates, which could force offsets, service limits, or waiver requests.
Based on analysis of 10 sections of legislative text.
Expands non-physician clinician authority in Medicare/Medicaid (prescribing, ordering, documenting, and substitution), strengthens LCD transparency, and adds an ACO assignment rule effective 2026.
Official title: 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 Jeff Merkley · Last progress February 13, 2025
Expands the role and authority of non-physician clinicians in Medicare and Medicaid by allowing nurse practitioners, physician assistants, clinical nurse specialists, certified nurse‑midwives, and certified registered nurse anesthetists to order, certify, prescribe, document, and substitute for physicians in specified rehabilitative, durable medical equipment, midwifery, anesthesia, and related services. It also tightens transparency and appeal rules for Medicare local coverage determinations and adds a new beneficiary assignment category for ACOs beginning in 2026. Most provisions take effect 90 days after enactment and HHS may implement by interim final rule or guidance to meet that timeline.