Sponsors (7)
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
The bill broadens who can provide and bill for Medicare/Medicaid services—improving access and provider participation—while increasing program costs, administrative burden, and the risk of variable access or care quality across states.
Medicare and Medicaid beneficiaries (and patients with chronic conditions) will have faster, broader access to care because NPs, PAs, CNSs, CRNAs, and CNMs are authorized to furnish, certify, or bill for more services previously limited to physicians.
Medicaid enrollees and hospitals may see improved anesthesia access and provider participation because CRNA services must be covered when state law permits and reimbursed at no less than Medicare physician-fee-schedule rates.
Hospice and other providers gain clearer payment rules and parity (e.g., NPs can bill hospice services at physician-fee-schedule percentages), which may expand provider options and standardize reimbursement.
Taxpayers and beneficiaries face higher federal and state program spending because expanded authority for non-physician clinicians and parity payments could increase billable services and hospice/Medicaid outlays.
Medicaid programs and state budgets may see materially higher costs because states must reimburse CRNA services at or above Medicare rates, potentially forcing offsets or program changes.
Expanding non-physician documentation, prescribing, and supervisory authority risks variability in quality of care and scope‑of‑practice conflicts across states, which could produce uneven clinical outcomes or legal disputes.
Based on analysis of 10 sections of legislative text.
Broadens which non‑physician clinicians may order/certify/authorize certain Medicare services, adjusts ACO assignment rules, mandates Medicaid payment treatment for CRNA services, and increases LCD transparency.
Expands which non‑physician clinicians can order, certify, prescribe, or document certain Medicare-covered services and clarifies payment and coverage rules for advanced practice clinicians. It also adds a new beneficiary assignment category for ACOs, increases contractor transparency for Local Coverage Determinations (LCDs), shortens appeal timing for posted LCDs, and requires CMS and states to change payments and benefit treatment for certain clinician services. The bill affects Medicare and some Medicaid rules: it broadens authorization for physician assistants, nurse practitioners, clinical nurse specialists, certified nurse‑midwives, and certified registered nurse anesthetists to furnish, order, or document services; mandates state Medicaid treatment and payment floors for CRNA services; and sets a default 90‑day post‑enactment effective date for most provisions, with CMS-directed interim implementation where needed.