I CAN Act

I 118TH CONGRESS 1ST SESSION H. R. 2713 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. IN THE HOUSE OF REPRESENTATIVES APRIL 19, 2023 Mr. JOYCE of Ohio (for himself, Ms. BONAMICI, Ms. UNDERWOOD, Mrs. KIGGANS of Virginia, Ms. SCHAKOWSKY, Mr. ARMSTRONG, Mr. BLU- MENAUER, Mr. SMITH of Nebraska, Mr. GROTHMAN, Mr. PAPPAS, and Ms. KUSTER) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend titles XVIII and XIX of the Social Security Act to increase access to services provided by advanced prac- tice registered nurses under the Medicare and Medicaid programs, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Improving Care and 4 Access to Nurses Act’’ or the ‘‘I CAN Act’’. 5 VerDate Sep 11 2014 00:42 Apr 26, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2713.IH H2713 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HR 2713 IH TITLE I—REMOVAL OF BAR- 1 RIERS TO PRACTICE ON 2 NURSE PRACTITIONERS 3 SEC. 101. EXPANDING ACCESS TO CARDIAC REHABILITA- 4 TION PROGRAMS AND PULMONARY REHA- 5 BILITATION PROGRAMS UNDER MEDICARE 6 PROGRAM. 7 (a) CARDIAC REHABILITATION PROGRAMS.—Section 8 1861(eee) of the Social Security Act (42 U.S.C. 9 1395x(eee)) is amended— 10 (1) in paragraph (2)— 11 (A) in subparagraph (A)(i), by striking ‘‘a 12 physician’s office’’ and inserting ‘‘the office of 13 a physician (as defined in subsection (r)(1)) or 14 the office of a nurse practitioner, clinical nurse 15 specialist, or physician assistant (as those terms 16 are defined in subsection (aa)(5))’’; and 17 (B) in subparagraph (C), by inserting ‘‘(as 18 defined in subsection (r)(1)), nurse practitioner, 19 clinical nurse specialist, or physician assistant 20 (as those terms are defined in subsection 21 (aa)(5))’’ after ‘‘physician’’; 22 (2) in paragraph (3)(A), by striking ‘‘physician- 23 prescribed exercise’’ and inserting ‘‘exercise pre- 24 scribed by a physician (as defined in subsection 25 VerDate Sep 11 2014 00:42 Apr 26, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2713.IH H2713 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HR 2713 IH (r)(1)), nurse practitioner, clinical nurse specialist, 1 or physician assistant (as those terms are defined in 2 subsection (aa)(5))’’; and 3 (3) in paragraph (5), by inserting ‘‘(as defined 4 in subsection (r)(1)), nurse practitioner, clinical 5 nurse specialist, or physician assistant (as those 6 terms are defined in subsection (aa)(5)),’’ after 7 ‘‘physician’’. 8 (b) PULMONARY REHABILITATION PROGRAMS.—Sec- 9 tion 1861(fff) of the Social Security Act (42 U.S.C. 10 1395x(fff)) is amended— 11 (1) in paragraph (2)(A), by striking ‘‘physician- 12 prescribed exercise’’ and inserting ‘‘exercise pre- 13 scribed by a physician (as defined in subsection 14 (r)(1)), nurse practitioner, clinical nurse specialist, 15 or physician assistant (as those terms are defined in 16 subsection (aa)(5))’’; and 17 (2) in paragraph (3), by inserting after ‘‘physi- 18 cian’’ the following: ‘‘(as defined in subsection 19 (r)(1)), nurse practitioner, clinical nurse specialist, 20 or physician assistant (as those terms are defined in 21 subsection (aa)(5)),’’. 22 VerDate Sep 11 2014 00:42 Apr 26, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2713.IH H2713 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •HR 2713 IH SEC. 102. PERMITTING NURSE PRACTITIONERS TO SATISFY 1 MEDICARE DOCUMENTATION REQUIREMENT 2 FOR COVERAGE OF CERTAIN SHOES FOR IN- 3 DIVIDUALS WITH DIABETES. 4 Section 1861(s)(12) of the Social Security Act (42 5 U.S.C. 1395x(s)(12)) is amended— 6 (1) in subparagraph (A), by inserting ‘‘, nurse 7 practitioner, or physician assistant’’ after ‘‘physi- 8 cian’’; and 9 (2) in subparagraph (C), by inserting ‘‘, nurse 10 practitioner, or physician assistant’’ after each oc- 11 currence of ‘‘physician’’. 12 SEC. 103. IMPROVEMENTS TO THE ASSIGNMENT OF BENE- 13 FICIARIES UNDER THE MEDICARE SHARED 14 SAVINGS PROGRAM. 15 Section 1899(c)(1) of the Social Security Act (42 16 U.S.C. 1395jjj(c)(1)) is amended— 17 (1) in subparagraph (A), by striking ‘‘and’’ at 18 the end; 19 (2) in subparagraph (B), by striking the period 20 at the end and inserting ‘‘; and’’; and 21 (3) by adding at the end the following new sub- 22 paragraph: 23 ‘‘(C) in the case of performance years be- 24 ginning on or after January 1, 2024, primary 25 care services provided under this title by an 26 VerDate Sep 11 2014 00:42 Apr 26, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2713.IH H2713 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •HR 2713 IH ACO professional described in subsection 1 (h)(1)(B).’’. 2 SEC. 104. EXPANDING THE AVAILABILITY OF MEDICAL NU- 3 TRITION THERAPY SERVICE MEDICARE PRO- 4 GRAM. 5 Section 1861(vv)(1) of the Social Security Act (42 6 U.S.C. 1395x(vv)(1)) is amended by inserting ‘‘, a nurse 7 practitioner, a clinical nurse specialist, or a physician as- 8 sistant (as such terms are defined in subsection (aa)(5))’’ 9 before the period at the end. 10 SEC. 105. PRESERVING ACCESS TO HOME INFUSION THER- 11 APY. 12 (a) ALLOWING APPLICABLE PROVIDERS TO ESTAB- 13 LISH HOME INFUSION THERAPY PLANS.—Section 14 1861(iii)(1)(B) of the Social Security Act (42 U.S.C. 15 1395x(iii)(1)(B)) is amended— 16 (1) by striking ‘‘a physician (as defined in sub- 17 section (r)(1))’’ and inserting ‘‘an applicable pro- 18 vider (as defined in paragraph (3)(A))’’; and 19 (2) by striking ‘‘a physician (as so defined)’’ 20 and inserting ‘‘an applicable provider (as so de- 21 fined)’’. 22 (b) CONFORMING AMENDMENT.—Section 1834(u)(6) 23 of the Social Security Act (42 U.S.C. 1395m(u)(6)) is 24 VerDate Sep 11 2014 00:42 Apr 26, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2713.IH H2713 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •HR 2713 IH amended by striking ‘‘physician’’ and inserting ‘‘applicable 1 provider (as defined in section 1861(iii)(3)(A))’’. 2 SEC. 106. INCREASING ACCESS TO HOSPICE CARE SERV- 3 ICES. 4 (a) IN GENERAL.—Section 1814(a)(7)(A) of the So- 5 cial Security Act (42 U.S.C. 1395f(a)(7)(A)) is amend- 6 ed— 7 (1) in clause (i)(I), by striking ‘‘a nurse practi- 8 tioner or’’; 9 (2) in clause (i), in the matter following sub- 10 clause (II), by inserting ‘‘or nurse practitioner’’ after 11 ‘‘physician’’ and inserting ‘‘, nurse practitioner’s’’ 12 after ‘‘physician’s’’; and 13 (3) in clause (ii), by striking ‘‘or physician’’ and 14 inserting ‘‘, physician, or nurse practitioner’’. 15 (b) HOSPICE CARE DEFINITION.—Section 16 1861(dd)(1)(C) of the Social Security Act (42 U.S.C. 17 1395x(dd)(1)(C)) is amended by adding ‘‘or nurse practi- 18 tioner’’ after ‘‘physician’’. 19 (c) NURSE PRACTITIONER BILLING.—Not later than 20 90 days after the date of the enactment of this Act, the 21 Secretary of Health and Human Services shall revise sec- 22 tion 418.304 of title 42, Code of Federal Regulations, to 23 allow nurse practitioners to bill for services not described 24 in paragraph (a) of such section in the same manner as 25 VerDate Sep 11 2014 04:55 Apr 26, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2713.IH H2713 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •HR 2713 IH physicians may bill for such services in accordance with 1 paragraph (b) of such section. Such revision shall provide 2 that such services furnished by a nurse practitioner shall 3 be payable at the percent of the physician fee schedule 4 specified in section 1833(a)(1)(O) of the Social Security 5 Act (42 U.S.C. 1395l(a)(1)(O)). 6 SEC. 107. STREAMLINING CARE DELIVERY IN SKILLED 7 NURSING FACILITIES AND NURSING FACILI- 8 TIES; AUTHORIZING MEDICARE AND MED- 9 ICAID INPATIENT HOSPITAL PATIENTS TO BE 10 UNDER THE CARE OF A NURSE PRACTI- 11 TIONER. 12 (a) MEDICARE.— 13 (1) CERTIFICATION OF POST-HOSPITAL EX- 14 TENDED CARE SERVICES.—Section 1814(a)(2) of the 15 Social Security Act (42 U.S.C. 1395f(a)(2)) is 16 amended by striking ‘‘, or a nurse practitioner,’’ and 17 inserting ‘‘or a nurse practitioner (in accordance 18 with State law), or’’. 19 (2) CERTIFICATION AUTHORITY FOR NURSE 20 PRACTITIONERS.—Section 1814(a)(3) of the Social 21 Security Act (42 U.S.C. 1395f(a)(3)) is amended by 22 inserting ‘‘or nurse practitioner’’ after ‘‘physician’’ 23 the first place that it appears. 24 VerDate Sep 11 2014 00:42 Apr 26, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2713.IH H2713 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •HR 2713 IH (3) SUPERVISION REQUIREMENT IN SKILLED 1 NURSING FACILITY SERVICES.—Section 2 1819(b)(6)(A) of the Social Security Act (42 U.S.C. 3 1395i–3(b)(6)(A)) is amended— 4 (A) in the header, by striking ‘‘Physician 5 supervision’’ and inserting ‘‘Supervision’’; and 6 (B) by inserting ‘‘or a nurse practitioner, 7 in accordance with State law’’ after ‘‘physi- 8 cian’’. 9 (4) ADMINISTRATION OF PART B.—Section 10 1842(b)(2)(C) of the Social Security Act (42 U.S.C. 11 1395u(b)(2)(C)) is amended— 12 (A) by inserting ‘‘or a nurse practitioner’’ 13 after ‘‘a physician’’; and 14 (B) by striking ‘‘or a nurse practitioner 15 working in collaboration with that physician, or 16 both’’. 17 (5) PROVISION OF MEDICAL AND OTHER 18 HEALTH SERVICES.—Section 1861(s)(2)(K)(ii) of 19 the Social Security Act (42 U.S.C. 20 1395x(s)(2)(K)(ii)) is amended by striking ‘‘or clin- 21 ical nurse specialist (as defined in subsection 22 (aa)(5)) working in collaboration (as defined in sub- 23 section (aa)(6)) with a physician (as defined in sub- 24 section (r)(1))’’ and inserting ‘‘(as defined in sub- 25 VerDate Sep 11 2014 00:42 Apr 26, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2713.IH H2713 pbinns on DSKJLVW7X2PROD with $$_JOB 9 •HR 2713 IH section (aa)(5)(A)), or by a clinical nurse specialist 1 (as defined in subsection (aa)(5)(B)) working in col- 2 laboration with a physician (as defined in subsection 3 (r)(1)),’’. 4 (6) PRIVILEGES FOR NURSE PRACTITIONERS.— 5 Section 1861 of the Social Security Act (42 U.S.C. 6 1395x) is amended— 7 (A) in subsection (e)(4), by inserting ‘‘(or 8 nurse practitioner, in accordance with State 9 law)’’ after ‘‘physician’’; 10 (B) in subsection (f)(1), by inserting ‘‘or 11 nurse practitioner,’’ after ‘‘physician’’; and 12 (C) in subsection (ee)(2), by inserting ‘‘or 13 nurse practitioner,’’ after ‘‘physician’’ each 14 place that it appears. 15 (b) MEDICAID.— 16 (1) CERTIFICATION AUTHORITY FOR NURSE 17 PRACTITIONERS.—Section 1902(a)(44) of the Social 18 Security Act (42 U.S.C. 1396a(a)(44)) is amended 19 to read as follows: 20 ‘‘(44) in each case for which payment for inpa- 21 tient hospital services, skilled nursing facility serv- 22 ices, services in an intermediate care facility de- 23 scribed in section 1905(d), or inpatient mental hos- 24 pital services is made under the State plan— 25 VerDate Sep 11 2014 00:42 Apr 26, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2713.IH H2713 pbinns on DSKJLVW7X2PROD with $$_JOB 10 •HR 2713 IH ‘‘(A) a physician or nurse practitioner (or, 1 in the case of skilled nursing facility services or 2 intermediate care facility services, a physician 3 or nurse practitioner, or a clinical nurse spe- 4 cialist who is not an employee of the facility but 5 is working in collaboration with a physician) 6 certifies at the time of admission, or, if later, 7 the time the individual applies for medical as- 8 sistance under the State plan (and a physician 9 or nurse practitioner, or a physician assistant 10 under the supervision of a physician, or, in the 11 case of skilled nursing facility services or inter- 12 mediate care facility services, a physician or 13 nurse practitioner, or a clinical nurse specialist 14 who is not an employee of the facility but is 15 working in collaboration with a physician, recer- 16 tifies, where such services are furnished over a 17 period of time, in such cases, at least as often 18 as required under section 1903(g)(6) (or, in the 19 case of services that are services provided in an 20 intermediate care facility, every year), and ac- 21 companied by such supporting material, appro- 22 priate to the case involved, as may be provided 23 in regulations of the Secretary), that such serv- 24 ices are or were required to be given on an in- 25 VerDate Sep 11 2014 00:42 Apr 26, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2713.IH H2713 pbinns on DSKJLVW7X2PROD with $$_JOB 11 •HR 2713 IH patient basis because the individual needs or 1 needed such services, and 2 ‘‘(B) such services were furnished under a 3 plan established and periodically reviewed and 4 evaluated by a physician or nurse practitioner, 5 or, in the case of skilled nursing facility services 6 or intermediate care facility services, by a phy- 7 sician or nurse practitioner, or a clinical nurse 8 specialist who is not an employee of the facility 9 but is working in collaboration with a physi- 10 cian;’’. 11 (2) NURSING FACILITY SERVICES SUPERVISION 12 AND CLINICAL RECORDS.—Section 1919(b)(6)(A) of 13 the Social Security Act (42 U.S.C. 1396r(b)(6)(A)) 14 is amended to read as follows: 15 ‘‘(A) require that the health care of every 16 resident be provided under the supervision of a 17 physician or nurse practitioner (or, at the op- 18 tion of a State, under the supervision of a clin- 19 ical nurse specialist or physician assistant who 20 is not an employee of the facility but who is 21 working in collaboration with a physician);’’. 22 VerDate Sep 11 2014 00:42 Apr 26, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H2713.IH H2713 pbinns on DSKJLVW7X2PROD with $$_JOB 12 •HR 2713 IH SEC. 108. IMPROVING ACCESS TO MEDICAID CLINIC SERV- 1 ICES. 2 Section 1905(a)(9) of the Social Security Act (42 3 U.S.C. 1396d(a)(9)) is amended by adding ‘‘or nurse 4 practitioner’’ after ‘‘physician’’ in both places that it ap- 5 pears. 6 TITLE II—REMOVAL OF BAR- 7 RIERS TO PRACTICE ON CER- 8 TIFIED REGISTERED NURSE 9 ANESTHETISTS 10 SEC. 201. CLARIFYING THAT CERTIFIED REGISTERED 11 NURSE ANESTHETISTS CAN BE REIMBURSED 12 BY MEDICARE FOR EVALUATION AND MAN- 13 AGEMENT SERVICES. 14 Section 1861(bb)(1) of the Social Security Act (42 15 U.S.C. 1395x(bb)(1)) is amended by inserting ‘‘, including 16 pre-anesthesia evaluation and management servic [Text truncated for display. Full text available on Congress.gov.]