New I CAN Act Expands Role of Nurse Practitioners, Aims to Boost Healthcare Access by Early 2025

The I CAN Act is all about breaking down barriers for nurse practitioners (NPs), certified registered nurse anesthetists (CRNAs), and certified nurse-midwives (CNMs) in Medicare and Medicaid. Basically, it lets these healthcare pros do more of what they're trained to do, aiming to make healthcare more accessible and efficient.

More Care, More Coverage

This bill expands what NPs and other advanced practice registered nurses (APRNs) can do. Key changes include:

• Rehab Services: NPs, physician assistants (PAs), and clinical nurse specialists can now prescribe and oversee cardiac and pulmonary rehab programs. Think of a farmer recovering from a heart attack – now they might access rehab services closer to home, thanks to a local NP. (Title I, Sec. 101)
• Diabetic Shoes: NPs and PAs can handle the paperwork for Medicare-covered diabetic shoes. This means a teacher with diabetes can get the footwear they need to prevent complications, with less hassle. (Title I, Sec. 102)
• Nutrition Therapy: NPs, clinical nurse specialists, and PAs can offer Medicare-covered medical nutrition therapy. So, someone managing a chronic condition can get dietary guidance from a wider range of providers. (Title I, Sec. 104)
• Hospice Care: NPs can now certify patients for hospice, expanding access to end-of-life care. (Title I, Sec. 106)
• Nursing Facilities: NPs gain authority to oversee care in skilled nursing facilities, potentially improving care quality. (Title I, Sec. 107)

CRNAs Get a Boost

The bill also targets specific changes for CRNAs:

• Billing for More: CRNAs can bill Medicare for a wider range of services, including pre-anesthesia evaluations. (Title II, Sec. 201)
• Less Red Tape: The bill removes the mandatory physician supervision requirement for CRNAs, recognizing their expertise. This could be a game-changer in rural areas where doctors are scarce. (Title II, Sec. 204)
• Medicaid Coverage: Medicaid must cover CRNA services, with fair payment rates. (Title II, Sec. 205)

Midwives Matter

Certified nurse-midwives also see expanded roles:

• Home Health Orders: CNMs can now order home health services for Medicare patients, improving access to in-home care. (Title III, Sec. 303)
• Medical Equipment: CNMs can order durable medical equipment (DME) like wheelchairs or walkers, streamlining the process for patients. (Title III, Sec. 304)

Transparency and Flexibility

This part of the bill focuses on making Medicare more transparent and adaptable:

• Clearer Coverage Decisions: Medicare contractors have to disclose the experts and criteria used in local coverage decisions. This means more openness about why certain services are covered. (Title IV, Sec. 401)
• No Provider Limits: Medicare can't restrict coverage based on a provider's qualifications – it's about the service, not the person providing it. (Title IV, Sec. 402)
• Locum Tenens: APRNs can use temporary substitute providers (locum tenens) and bill Medicare, ensuring continuous care for patients. (Title IV, Sec. 403)

Real-World Rollout

All these changes are set to kick in within 90 days of the bill becoming law. The Secretary of Health and Human Services can even issue temporary rules to speed things up. (Title V, Sec. 501) So, we could see these changes taking effect in early 2025.

The Bottom Line: The I CAN Act aims to make healthcare more accessible by empowering APRNs. While it could mean better care, especially in underserved areas, there's also the challenge of ensuring consistent quality as APRNs take on more responsibility. It's a big shift, and how it plays out in practice will be key.