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Expands Medicare and Medicaid coverage, ordering, certification, and payment authority for a range of non‑physician clinicians — including nurse practitioners, physician assistants, clinical nurse specialists, certified registered nurse anesthetists (CRNAs), and certified nurse‑midwives (CNMs). It requires HHS to update certain regulations, changes beneficiary assignment rules for ACOs starting in 2026, increases transparency and limits on local coverage determinations, and sets a general effective date 90 days after enactment.
The bill expands access to a wider set of non‑physician clinicians and increases transparency in Medicare coverage decisions—improving access and workforce flexibility—while raising program and state costs, administrative burdens, and potential variability in oversight and care quality.
Medicare and Medicaid patients (especially older adults, people with chronic conditions, pregnant people, and low‑income patients) will gain broader access to care because nurse practitioners, physician assistants, clinical nurse specialists, CRNAs, and CNMs can order, certify, and bill for a wider range of services (cardiac/pulmonary rehab, therapeutic shoes, medical nutrition therapy, hospice/SN
Medicaid enrollees will have guaranteed access to CRNA services because states must cover CRNA services as mandatory Medicaid benefits and pay providers at no less than Medicare‑equivalent rates, supporting anesthesia access in Medicaid populations.
Medicare beneficiaries and providers get greater transparency and earlier recourse on local coverage determinations (LCDs) because contractors must disclose consulted experts/guidance and providers may file complaints once an LCD is posted, improving oversight and the ability to challenge coverage rules.
Many Medicare and Medicaid patients could experience variability in care and oversight because expanded certification, supervision, and reduced supervision for NPs, PAs, CNSs, CRNAs, and CNMs may lead to inconsistent practice standards and care coordination across states and settings.
Taxpayers, state budgets, and federal programs may face higher costs because expanded provider billing (including added CRNA Medicaid payments at Medicare‑equivalent rates and more services billed by additional provider types) can raise program spending and shift reimbursement patterns.
Hospitals, SNFs, hospices, contractors, and CMS will incur administrative, compliance, and system‑update costs (including training, billing/pricing changes, enrollment/verification updates, and new disclosure/penalty requirements), imposing operational burdens across the health system.
Introduced February 13, 2025 by Jeff Merkley · Last progress February 13, 2025