The Improving Care and Access to Nurses (ICAN) Act introduced by Congresswoman Lucille Roybal-Allard (D-CA) would remove barriers to practice under the Medicare and Medicaid programs by increasing access to health care services provided by advanced practice registered nurses (APRNs), as described in a press conference held on Capitol Hill, September 13, 2022.  

Currently, more than 200,000 APRNs, including nurse practitioners (NPs), clinical nurse specialists, certified registered nurse anesthetists, and certified nurse-midwives, are treating Medicare patients, and approximately 40% of Medicare beneficiaries are receiving care from APRNs.

The ICAN Act (HR 8812) aims to remove administrative and practice barriers by authorizing APRNs to order and supervise cardiac and pulmonary rehabilitation, order diabetic shoes, refer patients for medical nutrition therapy, certify and recertify a patient’s terminal illness for hospice eligibility, and perform all mandatory examinations in skilled nursing facilities. If passed, the act would allow APRN patients to fully be included in the beneficiary attribution process for the Medicare Shared Savings Program. The act would amend titles XVIII and XIX of the Social Security Act and the Bipartisan Budget Act of 2018.


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This legislation is consistent with the recommendations from numerous health care stakeholders, including the National Academy of Medicine (NAM) in their The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity report. In this report, NAM 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.”

Nursing Associations Support ICAN Act

Rep Roybal-Allard was joined at the press conference by leaders from the American Association of Nurse Practitioners (AANP), American Nurses Association (ANA), American Association of Nurse Anesthesiology (AANA), and American College of Nurse-Midwives (ACNM).

April Kapu AANP
April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN

“I have cared for hundreds and hundreds of patients who have undergone cardiac and thoracic surgery,” said AANP President April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, at the press conference. “Cardiac and pulmonary services are vital to their recovery and healing process. We cannot have delays in these much needed services…. It is time that Medicare and Medicaid programs fully recognize our modern health care workforce.”

“It is critical that laws and regulations facilitate the most efficient relationships between health care 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,” stated ACNM CEO Katrina Holland. “Decades of research demonstrates that midwifery care can improve maternal health outcomes, the ICAN Act ensures that certified nurse-midwives can bring their evidenced-based skillset and knowledge to fully meet the needs of their patients.”

“Nurses play a critical role in our health care delivery system, often by serving as the primary source of care in many communities. This is especially true of APRNs who were able to practice at the top of their license during the height of the pandemic, due to waivers granted by Federal and state governments, and in doing so provided access to high-quality care for COVID-19 and non-COVID-19 patients alike,” said ANA President Ernest Grant, PhD, RN, FAAN. “Modern health care requires flexibility. We cannot not be hindered by antiquated barriers to practice or petty turf wars over perceived hierarchies. The health of our patients and communities must come first. The ICAN Act means that APRNs, including nurse practitioners, nurse anesthetists, nurse-midwives, and clinical nurse specialists will be able to care for their patients at the fullest extent of their abilities while experiencing fewer disruptions and less interference.”

Sources

Nursing associations applaud legislation to remove practice. News release. American Nurse Association. September 13, 2022. Accessed September 13, 2022. https://www.nursingworld.org/news/news-releases/2022-news-releases/nursing-associations-applaud-legislation-to-remove-practice-barriers/

AANP applauds U.S. House legislation strengthening patient access to health care. News release. American Association of Nurse Practitioners. September 13, 2022. Accessed September 13, 2022. https://www.aanp.org/news-feed/aanp-applauds-us-house-legislation-strengthening-patient-access-to-health-care