More than 235 health care organizations declared their support for The Improving Care and Access to Nurses Act (ICAN Act, HR 2713) in a letter sent to the U.S. House of Representatives Committee on Ways and Means and the Committee on Energy and Commerce on June 6, 2023.
This bipartisan legislation, which was reintroduced in April 2023 in the House of Representatives and in July 2023 in the Senate, would remove administrative and practice barriers under Medicare and Medicaid for advanced practice registered nurses (APRNs) and PAs (Table).
The act would amend titles XVIII and XIX of the Social Security Act and allow patients managed by nurse practitioners (NPs) and clinical nurse specialists to fully be included in the beneficiary attribution process for the Medicare Shared Savings Program. Over 40% of Medicare beneficiaries receive care from NPs, and NPs are the fastest-growing Medicare provider group, according to the American Association of Nurse Practitioners (AANP).
Table. Proposed Removal of Barriers to APRNs and PAs in the ICAN Act
|Bill Provision||Clinician Type|
|Sec. 101: Expanding access to cardiac rehabilitation programs and pulmonary rehabilitation programs under the Medicare program||CNS, NP, and PA|
|Sec. 102: Permitting nurse practitioners to satisfy documentation requirement for coverage of certain shoes for individuals with diabetes||NP and PA|
|Sec. 103: Improvements to the assignment of beneficiaries under the Medicare Shared Savings Program (MSSP)||CNS, NP, and PA|
|Sec. 104: Expanding the availability of medical nutrition therapy services under the Medicare Program||CNS, NP, and PA|
|Sec. 105: Preserving access to home infusion therapy||NP and PA|
|Sec. 106: Increasing access to hospice care services||NP|
|Sec. 107: Streamlining care delivery in skilled nursing facilities (SNFs) and nursing facilities and authorizing Medicare and Medicaid Patients to be under the care of a nurse practitioner in a hospital||NP|
|Sec. 108: Improving access to Medicaid clinic services||NP|
|Sec. 201: Amendments to Section 1861 of the Social Security Act Sec. 202: Revision of Conditions of Payment Relating to Services Ordered and Referred by Certified Registered Nurse Anesthetists Sec. 203: Special Payment Rule for Teaching Anesthesiologists Sec. 204: Removing Unnecessary and Costly Physician Supervision Sec. 205: CRNA Services as Medicaid-Required Benefit||CRNA|
|Sec. 301: Improving access to training in maternity care Sec. 302: Improving Medicare patient access to home health services provided by CNMs Sec. 303. Improving access to DMEPOS for Medicare beneficiaries Sec. 304: Technical changes to qualifications and conditions of CNMs’ services||CNM|
“This critical legislation will remove outdated barriers to practice that delay access to health care for our patients,” said outgoing AANP immediate past-president April Kapu, DNP. “Health care policies should be responsive to patient needs and inclusive of the health care providers delivering care in our communities. The ICAN Act will move health care delivery forward for patients, providers, and our nation.”
“Every day, nurse practitioners are striving to meet our country’s growing need for high-quality health care in all practice settings yet outdated federal barriers limit patient access to NP-provided care,” said AANP President Stephen Ferrara, DNP. “It is vital that the millions of Medicare and Medicaid patients who choose NPs receive timely access to high-quality health care. AANP applauds the introduction of the ICAN Act by Senators Merkley and Lummis in the US Senate, and we urge its swift passage by Congress.”
This legislation is particularly important for patients in rural and underserved communities who are more likely to receive care from APRNs. In 2018, APRNs and PAs represented approximately 50% of clinicians who billed Medicare in rural areas, to data from MedPac.
“The purpose of the ICAN Act is to increase access, improve quality of care, and lower costs in the Medicare and Medicaid programs by removing federal barriers to practice for APRNs, consistent with state law,” the organizations stated in the letter.
Editor’s Note: This article was updated on July 25, 2023.
More than 235 organizations show their support for the Improving Care and Access to Nurses Act. News release. American Association of Nurse Practitioners; June 6, 2023. Accessed June 9. 2023. https://www.aanp.org/news-feed/more-than-235-organizations-show-their-support-for-the-ican-act
AANP applaudes Senate introduction of ICAN Act. American Association of Nurse Practitioners; July 30, 2023. https://www.aanp.org/news-feed/aanp-applauds-senate-introduction-of-ican-act-2