To amend titles XVIII and XIX of the Social Security Act to increase access to services provided by advanced practice registered nurses under the Medicare and Medicaid programs, and for other purposes.
Analysis under review: This bill has generated analysis that may be too generic or incomplete. Clause-level evidence remains available below.
Summary
What This Bill Does
This bill significantly expands the authority of Advanced Practice Registered Nurses (APRNs) to provide medical services under Medicare and Medicaid without requiring physician supervision. It allows nurse practitioners, certified nurse-midwives, clinical nurse specialists, and certified registered nurse anesthetists to independently order, certify, and refer services to the extent permitted by state law.
Who Benefits and How
Advanced Practice Registered Nurses benefit by gaining expanded authority to practice independently and receive direct Medicare/Medicaid reimbursement for services they are authorized to provide under state law. Patients in underserved areas benefit from increased access to healthcare services, as the bill removes barriers that previously required physician involvement. Healthcare facilities, especially skilled nursing facilities and rural hospitals, benefit from greater workforce flexibility.
Who Bears the Burden and How
Physicians and physician groups may face increased competition from APRNs who can now provide overlapping services independently. Anesthesiologists may see reduced demand as CRNAs can practice without supervision requirements. Medicare Administrative Contractors face new transparency requirements and potential civil penalties for non-compliance with local coverage determination rules.
Key Provisions
- Allows CRNAs to order, certify, and refer services without physician supervision (to extent allowed by state law)
- Removes federal requirement for CRNA physician supervision while preserving state authority
- Makes CRNA services a required Medicaid benefit
- Expands nurse practitioner authority in skilled nursing facilities, home health, cardiac/pulmonary rehabilitation, and diabetes care
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers.
At a Glance
What This Bill Does
Expands the scope of services that Advanced Practice Registered Nurses (APRNs) including nurse practitioners, certified nurse-midwives, clinical nurse specialists, and certified registered nurse anesthetists can provide and be reimbursed for under Medicare and Medicaid programs.
Key Policy Areas
Healthcare, Medicare, Medicaid, Nursing Practice
Primary Purpose
Expands the scope of services that Advanced Practice Registered Nurses (APRNs) including nurse practitioners, certified nurse-midwives, clinical nurse specialists, and certified registered nurse anesthetists can provide and be reimbursed for under Medicare and Medicaid programs.
Policy Domains
Title I - Improving Access to Care Under Medicare
Identified Gains
Contextual inference, no direct clause citation- Nurse practitioners
- Clinical nurse specialists
- Physician assistants
- Medicare patients in underserved areas
- Skilled nursing facilities
Contextual inference, no direct clause citation
Identified Costs
Contextual inference, no direct clause citation- Physicians
- Physician-led practices
Contextual inference, no direct clause citation
Title V - Effective Date
Identified Gains
Contextual inference, no direct clause citation- APRNs seeking immediate practice expansion
Contextual inference, no direct clause citation
Identified Costs
Contextual inference, no direct clause citation- HHS implementation staff
Contextual inference, no direct clause citation
Title II - Improving Access to Care Furnished by CRNAs
Identified Gains
Contextual inference, no direct clause citation- Certified registered nurse anesthetists
- Hospitals and surgical centers
- Medicaid patients
Contextual inference, no direct clause citation
Identified Costs
Contextual inference, no direct clause citation- Anesthesiologists
- Physician anesthesia groups
- State Medicaid programs
Contextual inference, no direct clause citation
Title IV - Miscellaneous
Identified Gains
Contextual inference, no direct clause citation- Healthcare providers
- APRNs serving as locum tenens
- Patients affected by local coverage determinations
Contextual inference, no direct clause citation
Identified Costs
Contextual inference, no direct clause citation- Medicare Administrative Contractors
Contextual inference, no direct clause citation
Title III - Improving Access to Care Furnished by CNMs
Identified Gains
Contextual inference, no direct clause citation- Certified nurse-midwives
- Maternity patients
- Medical training programs
- Home health agencies
Contextual inference, no direct clause citation
Identified Costs
Contextual inference, no direct clause citation- Obstetricians
- Physician-led maternity practices
Contextual inference, no direct clause citation
Sponsors
Legislative Progress
IntroducedMr. Merkley (for himself and Ms. Lummis) introduced the following …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
APRNs awaiting expanded practice authority, APRNs subject to LCD credential restrictions, Anesthesiologist assistants
Positive-direction: APRNs awaiting expanded practice authority, APRNs subject to LCD credential restrictions, CRNAs, nurse practitioners, and nurse-midwives, Certified nurse-midwives, Certified registered nurse anesthetists, Clinical nurse specialists, Healthcare providers affected by LCD restrictions, Nurse practitioners and clinical nurse specialists, Nurse practitioners in skilled nursing facilities, Nurse practitioners ordering home infusion therapy, Nurse practitioners providing cardiac/pulmonary rehab, Nurse practitioners treating diabetic patients, Physician assistants, Physician assistants treating diabetic patients, Registered dietitians and nutrition professionals
Negative-direction: Anesthesiologist assistants
Maternity care patients, Medicaid patients needing anesthesia services, Medicare diabetic patients needing therapeutic shoes
Anesthesiologists, Cardiologists and pulmonologists, Physicians providing SNF supervision
Healthcare facilities using temporary staffing, Hospitals and ambulatory surgical centers, Medical residency training programs
DMEPOS suppliers, Therapeutic footwear suppliers and manufacturers
Home health agencies, Home infusion therapy providers
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "the_secretary"
- → Secretary of Health and Human Services
- "the_secretary"
- → Secretary of Health and Human Services
- "the_secretary"
- → Secretary of Health and Human Services
- "the_secretary"
- → Secretary of Health and Human Services
- "the_secretary"
- → Secretary of Health and Human Services
Key Definitions
Terms defined in this bill
A registered nurse who is certified to provide maternity care services
A registered professional nurse who performs advanced nursing services and meets certification requirements
A registered nurse who is licensed as a nurse anesthetist and meets certification requirements
For home infusion therapy, expanded to include nurse practitioners and other APRNs in addition to physicians
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology