The Improving Care and Access to Nurses Act, or I CAN Act, would amend the Social Security Act to expand the role of advanced practice registered nurses in Medicare and Medicaid. The bill is organized into five titles and makes a broad set of changes affecting nurse practitioners, certified registered nurse anesthetists (CRNAs), and certified nurse-midwives. Across those titles, it would allow these practitioners to perform or certify a wider range of covered services, including cardiac and pulmonary rehabilitation referrals, diabetic shoe documentation, medical nutrition therapy, home infusion therapy plans, hospice-related billing, skilled nursing facility and inpatient certification functions, Medicaid clinic services, anesthesia-related services, maternity care training, home health and durable medical equipment documentation, and certain Medicare local coverage and locum tenens rules.
A major theme of the bill is removing federal payment and supervision barriers that currently limit practice by APRNs under Medicare and Medicaid. For nurse practitioners, the bill expands authority in areas such as rehabilitation programs, hospice, skilled nursing facilities, inpatient hospital and Medicaid certification, and clinic services. For CRNAs, it clarifies reimbursement for evaluation and management services, permits ordering and referral authority to the extent allowed by state law, removes certain supervision requirements, and makes CRNA services a Medicaid-required benefit. For certified nurse-midwives, it expands access to training, home health, and DMEPOS-related documentation and makes technical corrections to their qualifications and billing-related provisions. The bill also revises Medicare local coverage determination procedures by requiring more transparency from Medicare administrative contractors and limiting their ability to impose practitioner-qualification restrictions.
If enacted, the bill would directly amend multiple sections of Titles XVIII and XIX of the Social Security Act and would also require the Secretary of Health and Human Services to update certain Medicare regulations and guidance. It would therefore affect federal reimbursement rules, coverage criteria, and provider qualification standards for Medicare and Medicaid, while leaving many of the underlying practice-authority questions to state law where the bill expressly references state authorization. The bill’s effective-date section generally applies the changes 90 days after enactment, with some provisions taking effect later or on a different schedule.
The overall sentiment reflected by the bill’s structure and sponsorship is supportive of expanding access to care through APRNs, with the stated policy goal of reducing administrative and supervisory barriers. The bill was introduced by Senator Merkley with Senator Lummis as a cosponsor and was referred to the Senate Committee on Finance. No committee transcript or recorded votes were provided, so there is no direct evidence in the supplied materials of opposition or amendment debate. Based on the text alone, the bill appears to be framed as a provider-access and patient-access measure rather than a cost-cutting or restrictive reform.
The main points of contention likely concern scope of practice, supervision, and payment parity. The bill would shift some authority away from physicians and toward nurse practitioners, CRNAs, and nurse-midwives, which could raise concerns among physician groups or facility operators about clinical oversight, quality assurance, and reimbursement impacts. It also creates new obligations for Medicare administrative contractors and HHS to revise rules quickly, which may draw scrutiny over implementation burden and federal administrative discretion. Supporters, by contrast, would likely emphasize improved access, especially in rural and underserved settings, and more efficient use of the health workforce.
The bill would amend numerous provisions of the Social Security Act governing Medicare and Medicaid to broaden the services that advanced practice registered nurses may furnish, certify, order, refer, or bill for under federal health programs. It would also require conforming regulatory changes by HHS, including updates to Medicare regulations and subregulatory guidance, and would alter local coverage determination procedures by Medicare administrative contractors. The practical effect would be to expand reimbursement eligibility and reduce federal supervision/documentation barriers for nurse practitioners, CRNAs, and certified nurse-midwives, while preserving state-law limits where the bill explicitly defers to state authorization.
The available materials suggest a generally favorable, access-oriented posture toward the bill. It was introduced with bipartisan sponsorship from Senators Merkley and Lummis and referred to committee without any recorded vote or hearing transcript in the provided record. The bill’s text is framed around improving access to care, reducing unnecessary barriers, and streamlining Medicare and Medicaid administration, indicating support for broader APRN utilization. No contrary statements or formal opposition are included in the supplied context.
The likely areas of contention are the expansion of APRN scope of practice, the reduction or elimination of physician supervision requirements, and the extension of reimbursement authority to non-physician providers. Physician organizations, hospitals, or other stakeholders may object to allowing nurse practitioners, CRNAs, and nurse-midwives to certify services, bill independently, or serve in roles traditionally reserved to physicians. There may also be concern about the bill’s implementation timeline, the mandate for HHS to revise regulations quickly, and the new transparency and penalty provisions for Medicare administrative contractors. Supporters would likely argue these changes improve access, especially in underserved areas, and better align payment rules with modern team-based care.