Sponsors (5)
Introduced February 13, 2025 by Jeff Merkley · Last progress February 13, 2025
The bill expands which advanced practice clinicians can certify, bill, and supervise Medicare/Medicaid services—improving access and provider participation—while increasing program costs, administrative burdens, and the risk of variable care and state-by-state access differences.
Medicare and Medicaid enrollees (especially people needing primary, chronic, anesthesia, midwifery, or homebound care) will gain faster, easier access because nurse practitioners, physician assistants, clinical nurse specialists, certified nurse‑midwives, and CRNAs are explicitly authorized to provide, certify, or supervise a wider range of covered services.
Hospices, CRNAs, and other advanced practice clinicians will have clearer/stronger payment rules (e.g., NP hospice billing at physician-fee-schedule percentage; Medicaid CRNA payments at no less than Medicare rates; expanded billing parity), which can increase provider participation and choice for patients.
Medicare beneficiaries and providers will get clearer reasons for local coverage decisions and an earlier ability for providers to challenge those decisions because contractors must post relied-on experts/guidelines and LCDs can be contested once posted.
Taxpayers and federal/state health programs may face higher costs because expanding the types of billable providers and raising payment parity (Medicare hospice payments, Medicaid CRNA rates, broader supervisory billing) is likely to increase utilization and program spending.
Patients and providers could see variable care quality and increased scope‑of‑practice disputes because broader clinician authority (NPs/PAs/CNSs/CRNAs/CNMs) plus differing state laws and certification rules may create uneven training, supervision, and legal conflicts.
CMS, Medicare contractors, providers, and hospitals will face meaningful administrative and compliance burdens (tight 90‑day implementation deadlines, required rule revisions, posting and disclosure requirements, and new billing processes), increasing costs and operational strain.
Based on analysis of 10 sections of legislative text.
Expands non‑physician clinicians' authority to order/certify/prescribe certain Medicare services, adjusts ACO assignment, increases LCD transparency, and sets near-term effective dates.
Expands which non-physician clinicians can order, certify, or prescribe certain Medicare-covered services (including cardiac and pulmonary rehabilitation, diabetic shoes, nutrition therapy, and midwifery services), clarifies payment and ordering authority for certified registered nurse anesthetists (CRNAs), and updates beneficiary assignment rules for accountable care organizations (ACOs). It also increases transparency and appeal timing for local coverage determinations (LCDs), treats certain advanced practice clinicians like physicians for locum tenens substitution, and requires HHS to implement many changes quickly (generally 90 days after enactment).