Sponsors (5)
Last progress June 10, 2025 (8 months ago)
Introduced on June 10, 2025 by Ashley Hinson
Allows certain preventive services called personalized prevention plan services to be covered when a registered nurse licensed in the State provides them. The change updates the Social Security Act so nurses can deliver and be paid for these specific preventive services starting the day the law takes effect.
Amends section 1861(aa)(1) of the Social Security Act (42 U.S.C. 1395x(aa)(1)) by modifying subparagraphs (C) and (D) (adjusting trailing conjunctions) and inserting a new subparagraph (E).
Adds new subparagraph (E) authorizing coverage of personalized prevention plan services (as defined in section 1861(hhh)(1)) when furnished by a registered nurse who is licensed to practice nursing in the State where the services are performed, and coverage of services and supplies furnished as incident to those services that would otherwise be covered if furnished by a physician or as incident to a physician’s service.
Sets the effective date: the amendments apply to items and services furnished on or after the date of enactment of this Act.
Who is affected and how:
Registered nurses: Directly benefit because they are explicitly authorized to provide (and have covered) personalized prevention plan services when licensed in the State where services are delivered. This may expand their scope of reimbursable activities and create new opportunities to deliver preventive care.
Medicare/Medicaid beneficiaries (and other people covered under the relevant parts of the Social Security Act): Likely gain improved access to preventive services, especially in areas with fewer physicians, because nurses can provide these covered services.
Other health care providers and health systems: May see shifts in how preventive care is staffed and delivered. Systems can reallocate tasks to nurses, potentially improving efficiency and capacity for preventive care delivery.
Payers and program administrators (e.g., CMS): Will need to update administrative guidance, billing codes interpretation, and provider enrollment/credentialing rules to reflect that registered nurses can be the covered provider for these services. Fiscal impact depends on any resulting change in utilization and how payments are structured; the amendment itself does not appropriate new funds.
States: Little direct change to state law; the provision relies on state licensure (nurses must be licensed in the State where services are provided). States continue to set nursing licensure standards, but the federal change may encourage use of nurse-delivered prevention services within those licensure frameworks.
Overall effect: This is a targeted, low-complexity change intended to increase access to covered preventive services by expanding who may provide them under existing coverage rules. Administrative updates are needed, but the policy is narrow and unlikely to require major program redesign.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.