HR1317-119

What This Bill Does

The I CAN Act is a broad advanced-practice clinician access bill. It expands Medicare cardiac and pulmonary rehabilitation rules so physician assistants, nurse practitioners, and clinical nurse specialists can prescribe or supervise covered rehabilitation services in office settings. It lets nurse practitioners and physician assistants satisfy Medicare documentation for diabetic shoes, expands medical nutrition therapy referrals, preserves home infusion access through applicable providers, and allows nurse practitioners to handle more inpatient hospital, skilled nursing facility, nursing facility, and Medicaid certification and supervision functions under state law. It gives certified registered nurse anesthetists authority to order, certify, and refer Part B services to the extent allowed by state law, bars physician-supervision requirements after CRNA certification, makes CRNA services a Medicaid-required benefit with payment rules, expands certified nurse-midwife training, home health, and DMEPOS authority, reforms Medicare local coverage determinations by requiring expert and source transparency and barring practitioner-qualification limits, adds penalties up to $10,000 for MAC failures, extends locum tenens treatment to several advanced practitioners, and requires implementation within 90 days through interim final rule or guidance if needed.

Who Benefits and How

Medicare beneficiaries benefit from broader access to rehabilitation, diabetic shoes, nutrition therapy, home infusion, home health, DMEPOS, and facility care ordered or furnished by advanced practitioners. Nurse practitioners benefit from expanded certification, supervision, inpatient, skilled nursing, nursing facility, and Medicare documentation authority. Physician assistants benefit from expanded rehabilitation, diabetic shoe, nutrition therapy, home infusion, DMEPOS, and locum tenens recognition. Clinical nurse specialists benefit from broader rehabilitation, nutrition therapy, facility, DMEPOS, and locum tenens roles. Certified registered nurse anesthetists benefit from Part B order/referral authority, removal of physician-supervision requirements, and Medicaid-required benefit status. Certified nurse-midwives benefit from expanded training, home health, DMEPOS, and locum tenens recognition.

Who Bears the Burden and How

HHS and CMS must implement extensive Medicare and Medicaid amendments within 90 days using interim final rules or guidance if needed. Medicare administrative contractors must disclose experts, communications, rules, guidelines, protocols, and criteria used in local coverage determinations. Physician groups may lose exclusive statutory control over services newly opened to advanced practice clinicians. State Medicaid agencies must cover and pay CRNA services using the required methodology. Federal taxpayers may bear higher Medicare or Medicaid spending if expanded ordering authority increases utilization. Hospitals, skilled nursing facilities, and home health agencies must update policies for advanced-practice clinician authority.

Key Provisions

• Expands Medicare rehabilitation, diabetic shoe, nutrition therapy, home infusion, facility-care, home health, DMEPOS, and locum tenens authority for advanced practice clinicians.
• Authorizes CRNAs to order, certify, and refer Part B services and removes physician-supervision requirements after certification.
• Requires Medicaid coverage and payment for CRNA services.
• Expands certified nurse-midwife training, home health, DMEPOS, and locum tenens recognition.
• Reforms Medicare local coverage determinations with transparency, practitioner-qualification limits, complaint timing, and $10,000 penalties.
• Requires HHS implementation within 90 days for most provisions through interim final rules or guidance if necessary.