The I CAN Act: Nurse Practitioners Gain Autonomy in Medicare/Medicaid, Ending Costly Supervision Mandates

The Improving Care and Access to Nurses Act, or the I CAN Act, is a major legislative effort to update federal healthcare rules by expanding the authority of Advanced Practice Registered Nurses (APRNs)—specifically Nurse Practitioners (NPs), Certified Registered Nurse Anesthetists (CRNAs), and Certified Nurse-Midwives (CNMs)—across Medicare and Medicaid. This bill tackles outdated regulations that currently require physician sign-offs or supervision for tasks that APRNs are already trained and licensed by their states to perform. The core purpose here is simple: to maximize the use of highly trained nurses to improve patient access to care, especially as the U.S. faces provider shortages.

Cutting the Red Tape for Everyday Care

For many people, the most immediate impact of the I CAN Act will be on routine, necessary medical services. Take, for example, a diabetic patient who needs specialized shoes covered by Medicare. Right now, only a physician can sign the necessary documentation. Section 102 changes this, allowing a Nurse Practitioner or a Physician Assistant to sign off on that paperwork. This isn't a minor administrative tweak; it means less waiting time for patients and frees up physician time for more complex cases. Similarly, the bill expands who can prescribe and supervise cardiac and pulmonary rehabilitation programs (Sec. 101), adding NPs, PAs, and Clinical Nurse Specialists to the list. If you need rehab, you no longer have to wait for a doctor's schedule to clear just to start your exercise program; a qualified NP can get the ball rolling.

The Anesthesia Autonomy Shift

One of the most significant changes involves Certified Registered Nurse Anesthetists (CRNAs). Historically, Medicare rules have required CRNAs to be supervised by a physician, a mandate often cited as unnecessary and costly, particularly in rural hospitals. Section 204 completely removes this mandatory physician supervision requirement for CRNAs under Medicare. This is a huge win for efficiency and access, allowing CRNAs to practice to the full extent of their state license. Furthermore, the bill makes CRNA services a required benefit under Medicaid (Sec. 205) and mandates that states pay CRNAs at the same rate Medicare uses for comparable services, ensuring fair compensation and encouraging CRNAs to serve Medicaid patients.

Streamlining Care in Facilities and Homes

The bill also addresses bottlenecks in institutional and home care. Section 107 gives NPs greater authority in skilled nursing facilities (SNFs) and hospitals, allowing them to certify the need for post-hospital care and supervise resident care plans, a role previously restricted to physicians. This is crucial for residents in SNFs, where care can often be delayed waiting for a physician's signature. For home health services, Certified Nurse-Midwives (CNMs) are now added to the list of professionals who can order home health and durable medical equipment (DMEPOS) for Medicare patients (Sec. 302, 303). If you or a loved one needs a hospital bed or home nursing after a procedure, a CNM can now initiate that process, making the transition home smoother and faster.

Holding Medicare Contractors Accountable

Beyond expanding nursing roles, the I CAN Act throws a spotlight on how Medicare makes coverage decisions. Section 401 requires Medicare Administrative Contractors (MACs)—the companies that process claims and create local rules—to be far more transparent about their Local Coverage Determinations (LCDs). When they create a new rule about what Medicare will cover, they must now publicly identify the experts they consulted (even if they ignored their advice) and provide direct links to all the documents they relied on. If a MAC fails to follow these new transparency rules, they face a civil monetary penalty of up to $10,000 per violation. This is a direct measure to ensure that coverage decisions are based on science, not administrative convenience, and it gives providers and patients a clear path to challenge decisions they disagree with.

The Takeaway: More Care, Less Waiting

Overall, the I CAN Act is a major modernization effort that recognizes the advanced training of APRNs. For the average person, this means better access to services, fewer administrative delays, and a wider choice of qualified providers, especially in areas struggling with physician shortages. While the bill is a clear benefit to nurses and patients, it does place new compliance burdens—and financial penalties—on Medicare contractors, and it shifts the competitive landscape for services previously dominated by physicians. The entire act is set to take effect 90 days after becoming law (Sec. 501), giving the Department of Health and Human Services a tight deadline to issue guidance and make sure these long-overdue changes actually roll out smoothly.