New Legislation Would Expand Authority for APRNs Treating Medicare and Medicaid Patients

The bill doesn't provide full practice authority, but it does recognize the role APRNs have in the U.S. healthcare system.

Newly introduced bipartisan legislation to improve healthcare access for Medicare and Medicaid beneficiaries would expand authority for advanced practice RNs (APRNs) to treat those patients.

The legislation does not provide full practice authority (FPA) in all 50 states—individual states govern those guidelines—but it does reduce a number of federal barriers that impede access to care for millions who receive healthcare through Medicare and Medicaid.

The Improving Care and Access to Nurses (ICAN) Act—or H.R. 8812—would allow APRNs, including nurse practitioners, nurse anesthetists, nurse-midwives, and clinical nurse specialists, to order and supervise cardiac and pulmonary rehabilitation, certify when patients with diabetes need therapeutic shoes, have their patients fully included in the beneficiary attribution process for the Medicare Shared Savings Program, refer patients for medical nutrition therapy, certify and recertify a patient’s terminal illness for hospice eligibility, perform all mandatory examinations in skilled nursing facilities, and more

The legislation, introduced by Rep. Lucille Roybal-Allard (D-Calif.) and Rep. Dave Joyce (R-Ohio), could benefit hundreds of thousands of patients. Today, more than 200,000 APRNs are treating Medicare patients, and about 40% of Medicare beneficiaries receive care from APRNs, according to a joint press release sent out by the nursing organizations.

Indeed, the legislation is consistent with recommendations from numerous healthcare stakeholders, including the National Academy of Medicine in its The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity report.

This report recommends that “all relevant state, federal, and private organizations enable nurses to practice to the full extent of their education and training by removing practice barriers that prevent them from more fully addressing social needs and social determinants of health and improve health care access, quality, and value.”

Strong support from nurse leaders

The legislation is receiving strong support from national nursing organizations:

• “The health of Medicare and Medicaid beneficiaries depends on timely access to high-quality healthcare,” said April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, president of the American Association of Nurse Practitioners (AANP). “It’s critically important that healthcare policies reflect who is providing care in our communities and that our healthcare system is effective and efficient. The ICAN Act would move healthcare delivery forward for patients, providers, and our nation.”
• “It is time for Congress to eliminate burdensome laws and regulations,” said Angela Mund, DNP, CRNA, president of the American Association of Nurse Anesthesiology (AANA). “Allowing certified registered nurse anesthetists and other APRNs to practice to the full scope of their training and licensure will ensure that patients are put first, that competition drives down costs through the removal of artificial and unnecessary barriers, and that providers of all types are able to better serve their patients.”
• “It is critical that laws and regulations facilitate the most efficient relationships between healthcare professionals and create systems in which midwives and other APRNs can communicate openly, practice collaboratively, and provide quality care that falls within everyone’s professional scope of practice,” said Katrina Holland, CEO of the American College of Nurse-Midwives. “Decades of research demonstrates that midwifery care can improve maternal health outcomes, and the ICAN Act ensures that certified nurse-midwives can bring their evidenced-based skillset and knowledge to fully meet the needs of their patients.”