Sponsors (5)
The bill expands access to care and strengthens workforce and regulatory transparency by authorizing many advanced practice clinicians to furnish, order, and document services and by speeding implementation — but those access and efficiency gains come with higher federal and state costs, uneven benefits across states with differing scope‑of‑practice laws, and increased administrative and oversight challenges.
Medicare and Medicaid beneficiaries (including people with chronic cardiac/pulmonary conditions, diabetes, and those needing anesthesia or midwifery care) will have expanded access because nurse practitioners, physician assistants, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse‑midwives can furnish, document, order, or refer for a wider set of services (e.
Clinicians and training programs (CRNAs, CNMs, residents/interns, and hospitals) will receive clearer payment rules and training support because Medicaid must cover CRNA services at no less than Medicare-equivalent rates, teaching/E/M payment rules for CRNAs are clarified, and certain PHSA grants may be used for CNM clinical training — strengthening workforce and clinical training capacity.
Patients and providers will benefit from faster, clearer regulatory implementation and greater transparency because the bill sets a uniform 90-day effective date for many provisions, allows HHS to use interim final rules for quicker deployment, requires CMS to revise hospice billing rules promptly, and mandates more disclosure around LCD development.
Taxpayers, Medicare and Medicaid programs, and state governments are likely to face higher costs because expanding who can bill for services and establishing Medicaid payment floors (e.g., for CRNAs) and new provider authorizations can increase program spending and state payment obligations.
Medicare and Medicaid beneficiaries in states with restrictive scope‑of‑practice laws may see little or no benefit because many access expansions depend on state law authorizing the non‑physician activities.
Hospitals, providers, MACs and taxpayers may face increased administrative and compliance burdens — including IT/billing updates, training costs, possible penalties for LCD process failures, and more immediate challenges or litigation — as new transparency and timing rules take effect.
Based on analysis of 10 sections of legislative text.
Expands Medicare and Medicaid coverage, payment, and ordering authority for advanced practice clinicians and increases transparency for local coverage decisions.
Introduced February 13, 2025 by Jeff Merkley · Last progress February 13, 2025
Expands which clinicians Medicare and Medicaid recognize, pay, and allow to order, certify, or refer services — especially advanced practice nurses (nurse practitioners, clinical nurse specialists), physician assistants, certified registered nurse anesthetists (CRNAs), and certified nurse‑midwives (CNMs). It also boosts transparency for Medicare local coverage determinations and extends certain locum tenens rules to advanced practice clinicians. Most of the changes take effect 90 days after enactment and HHS must issue implementing guidance or interim rules as needed. The bill adjusts coverage and documentation rules (for services such as cardiac/pulmonary rehab, therapeutic shoes, medical nutrition therapy, home infusion, hospice, and DMEPOS), requires Medicare administrative contractors to publish expert inputs and relied-upon materials for local coverage decisions, and adds CRNA services to Medicaid mandatory benefits with a payment floor tied to Medicare rates.