PlainBillCongress, translated.Legislation. Context. Public interest.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.
Congressional Research Service
Version 00 · Introduced in House · Feb 13, 2025
Improving Care and Access to Nurses Act or the I CAN Act
This bill allows other health care providers besides physicians (e.g., nurses) to provide certain services under Medicare and Medicaid.
Among other changes, the bill (1) allows a nurse practitioner or physician assistant to fulfill documentation requirements for Medicare coverage of special shoes for diabetic individuals; (2) expedites the ability of physician assistants, nurse practitioners, and clinical nurse specialists to supervise Medicare cardiac, intensive cardiac, and pulmonary rehabilitation programs; and (3) allows nurse practitioners to certify the need for inpatient hospital services under Medicare and Medicaid.
People & committees
Rep. Joyce, David P. [R-OH-14] · R–OH
Legislative record
A procedural vote is different from passage. Passage in one chamber does not establish enactment. Explore the glossary.
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.
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.
Introduced in House
Introduced in House
Primary sources
Text links open the official source. We also preserved the text version used in the PlainBill explanation below.
Source last updated: Sep 19, 2026. Consult Congress.gov for the current record.
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PlainBill explanation
Based on the full Introduced in House · 2025-02-13 text. This explanation has not received human editorial review. This overview describes the proposal’s major provisions; it does not establish what its real-world effects would be.
The bill would expand the roles of advanced practice nurses in care paid for by Medicare and Medicaid, with some changes also covering physician assistants. It would change who can prescribe, supervise, or bill for specified services and add requirements for Medicare contractors’ local coverage decisions. Several permissions would remain subject to state law. These are proposals in the introduced bill, not evidence of enacted changes.
exercise prescribed by a physician (as defined in subsection (r)(1)) or a physician assistant, nurse practitioner, or clinical nurse specialist
require that the health care of every resident be provided under the supervision of a physician or nurse practitioner
(1) certified registered nurse anesthetists are authorized to order, certify, and refer services to the extent allowed under the law of the State in which the services are furnished; and (2) payment shall be made under such part for such services so ordered, certified, or referred by certified registered nurse anesthetists.
Identification of any medical or scientific experts whose advice was obtained by such contractor during the development of such determination
2025-02-13: Introduced in House
Section 101 would allow physician assistants, nurse practitioners, and clinical nurse specialists to prescribe exercise for Medicare cardiac and pulmonary rehabilitation. It would also add those professionals to other specified rehabilitation provisions and replace “a physician’s office” with “the office setting” in the cardiac rehabilitation provision.
by striking a physician’s office and inserting the office setting
by striking physician-prescribed exercise and inserting exercise prescribed by a physician (as defined in subsection (r)(1)) or a physician assistant, nurse practitioner, or clinical nurse specialist (as those terms are defined in subsection (aa)(5))
(b) Pulmonary rehabilitation programs Section 1861(fff) of the Social Security Act (42 U.S.C. 1395x(fff)) is amended— (1) in paragraph (2)(A), by striking physician-prescribed exercise and inserting exercise prescribed by a physician (as defined in subsection (r)(1)) or a physician assistant, nurse practitioner, or clinical nurse specialist (as those terms are defined in subsection (aa)(5)); and (2) in paragraph (3), by inserting after physician the following: (as defined in subsection (r)(1)) or a physician assistant, nurse practitioner, or clinical nurse specialist (as those terms are defined in subsection (aa)(5)).
Section 102 would add nurse practitioners and physician assistants to specified Medicare documentation provisions for coverage of certain shoes for people with diabetes. The underlying documentation requirements are not reproduced.
102. Permitting nurse practitioners and physician assistants to satisfy Medicare documentation requirement for coverage of certain shoes for individuals with diabetes Section 1861(s)(12) of the Social Security Act (42 U.S.C. 1395x(s)(12)) is amended— (1) in subparagraph (A), by inserting , nurse practitioner, or physician assistant after physician; and (2) in subparagraph (C), by inserting , nurse practitioner, or physician assistant after each occurrence of physician.
Section 103 would add another category of primary-care services to Medicare shared savings program rules for assigning patients to participating provider groups. The addition would apply to performance years beginning on or after January 1, 2026. The covered professionals are identified through a statutory reference whose definition is not supplied.
103. Improvements to the assignment of beneficiaries under the Medicare shared savings program
(C) in the case of performance years beginning on or after January 1, 2026, primary care services provided under this title by an ACO professional described in subsection (h)(1)(B).
Section 104 would add nurse practitioners, clinical nurse specialists, and physician assistants to a Medicare provision governing medical nutrition therapy. Because the existing sentence is not reproduced, the supplied text does not fully explain the role being expanded.
104. Expanding the availability of medical nutrition therapy service Medicare program Section 1861(vv)(1) of the Social Security Act (42 U.S.C. 1395x(vv)(1)) is amended by inserting or a nurse practitioner, a clinical nurse specialist, or a physician assistant (as such terms are defined in subsection (aa)(5)) before the period at the end.
Section 105 would replace physician references with “applicable provider” in provisions for establishing home infusion therapy plans and in a related provision. The bill points to an existing definition of eligible providers but does not reproduce it.
(a) Allowing applicable providers To establish home infusion therapy plans Section 1861(iii)(1)(B) of the Social Security Act (42 U.S.C. 1395x(iii)(1)(B)) is amended— (1) by striking a physician (as defined in subsection (r)(1)) and inserting an applicable provider (as defined in paragraph (3)(A)); and (2) by striking a physician (as so defined) and inserting an applicable provider (as so defined).
Section 1834(u)(6) of the Social Security Act (42 U.S.C. 1395m(u)(6)) is amended by striking physician and inserting applicable provider (as defined in section 1861(iii)(3)(A)).
Section 106 would revise hospice payment provisions to include nurse practitioners and add them to the hospice-care definition. Within 90 days after enactment, the Secretary of Health and Human Services would have to revise the billing regulation so nurse practitioners could bill for the specified services in the same manner as physicians. Payment would use an existing statutory percentage of the physician fee schedule; the bill does not state that percentage.
(A) in subclause (I), by striking a nurse practitioner or; (B) in subclause (II), by inserting or nurse practitioner after physician; and (C) in the flush matter following subclause (II), by inserting , nurse practitioner’s, after physician’s; and (2) in clause (ii), by striking or physician and inserting , physician, or nurse practitioner.
(b) Hospice care definition Section 1861(dd)(1)(C) of the Social Security Act (42 U.S.C. 1395x(dd)(1)(C)) is amended by inserting or nurse practitioner after physician.
Not later than 90 days after the date of the enactment of this Act, the Secretary of Health and Human Services shall revise section 418.304 of title 42, Code of Federal Regulations, to allow nurse practitioners to bill for services not described in paragraph (a) of such section in the same manner as physicians may bill for such services in accordance with paragraph (b) of such section. Such revision shall provide that such services furnished by a nurse practitioner shall be payable at the percent of the physician fee schedule specified in section 1833(a)(1)(O) of the Social Security Act (42 U.S.C. 1395l(a)(1)(O)).
Section 107 would add nurse practitioners to Medicare certification, skilled nursing facility supervision, resident-rights, and hospital-care provisions. It expressly retains state-law qualifications in the specified post-hospital certification, skilled nursing supervision, and hospital provisions.
(1) Certification of post-hospital extended care services Section 1814(a)(2) of the Social Security Act (42 U.S.C. 1395f(a)(2)) is amended, in the matter preceding subparagraph (A), by striking , or a nurse practitioner, and inserting or a nurse practitioner (in accordance with State law), or.
(2) Certification authority for nurse practitioners Section 1814(a)(3) of the Social Security Act (42 U.S.C. 1395f(a)(3)) is amended by inserting or nurse practitioner after physician.
(II) in subparagraph (A), by inserting or a nurse practitioner, in accordance with State law after physician; and (B) in subsection (c)— (i) in subparagraph (1)(A)(i), by inserting or nurse practitioner after attending physician; (ii) in the flush matter at the end of subparagraph (2)(A), by inserting or nurse practitioner after physician in each occurrence; and (iii) in subparagraph (3)(A), by inserting or nurse practitioner after physician.
(6) Privileges for nurse practitioners Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended— (A) in subsection (e)(4), by inserting (or nurse practitioner, in accordance with State law) after physician; (B) in subsection (f)(1), by inserting or nurse practitioner after physician; and (C) in each of subparagraphs (B) and (F) of subsection (ee)(2), by inserting or nurse practitioner after physician.
Section 107 would remove physician-collaboration language for nurse practitioners from two specified Medicare provisions. In the amended medical-services provision, clinical nurse specialists would still be described as working in collaboration with a physician.
(4) Administration of part B Section 1842(b)(2)(C) of the Social Security Act (42 U.S.C. 1395u(b)(2)(C)) is amended, in the second sentence— (A) by inserting or a nurse practitioner after a physician; and (B) by striking or a nurse practitioner working in collaboration with that physician, or both.
by striking or clinical nurse specialist (as defined in subsection (aa)(5)) working in collaboration (as defined in subsection (aa)(6)) with a physician (as defined in subsection (r)(1)) and inserting (as defined in subsection (aa)(5)(A)), or by a clinical nurse specialist (as defined in subsection (aa)(5)(B)) working in collaboration with a physician (as defined in subsection (r)(1)),.
Section 107 would allow nurse practitioners to certify and recertify the need for specified Medicaid inpatient and facility services and to establish and review care plans. Initial certification would be required at admission or, if later, when the person applies for Medicaid. Repeat certification would follow the referenced statutory schedule, with annual recertification for intermediate care facility services.
in each case for which payment for inpatient hospital services, skilled nursing facility services, services in an intermediate care facility described in section 1905(d), or inpatient mental hospital services is made under the State plan
a physician or nurse practitioner (or, in the case of skilled nursing facility services or intermediate care facility services, a physician or nurse practitioner, or a clinical nurse specialist who is not an employee of the facility but is working in collaboration with a physician) certifies at the time of admission, or, if later, the time the individual applies for medical assistance under the State plan
a physician or nurse practitioner, or a physician assistant under the supervision of a physician, or, in the case of skilled nursing facility services or intermediate care facility services, a physician or nurse practitioner, or a clinical nurse specialist who is not an employee of the facility but is working in collaboration with a physician, recertifies, where such services are furnished over a period of time, in such cases, at least as often as required under section 1903(g)(6) (or, in the case of services that are services provided in an intermediate care facility, every year)
such services were furnished under a plan established and periodically reviewed and evaluated by a physician or nurse practitioner
For Medicaid nursing facilities, section 107 would permit residents’ care to be supervised by a physician or nurse practitioner. A state could also allow supervision by a clinical nurse specialist or physician assistant, provided that professional is not employed by the facility and works in collaboration with a physician.
require that the health care of every resident be provided under the supervision of a physician or nurse practitioner (or, at the option of a State, under the supervision of a clinical nurse specialist or physician assistant who is not an employee of the facility but who is working in collaboration with a physician)
Section 108 would add nurse practitioners alongside physicians in both places specified in Medicaid’s clinic-services provision. The underlying provision is not reproduced, so the full service requirements are not available in this bundle.
108. Improving access to Medicaid clinic services Section 1905(a)(9) of the Social Security Act (42 U.S.C. 1396d(a)(9)) is amended by adding or nurse practitioner after physician in both places that it appears.
Section 201 would expressly include pre-anesthesia evaluation and management services in the Medicare provision for certified registered nurse anesthetist services.
201. Clarifying that certified registered nurse anesthetists can be reimbursed by Medicare for evaluation and management services Section 1861(bb)(1) of the Social Security Act (42 U.S.C. 1395x(bb)(1)) is amended by inserting , including pre-anesthesia evaluation and management services, after and related care.
Section 202 would require a regulation change within three months after enactment. It would clarify that certified registered nurse anesthetists may order, certify, and refer services within the authority state law allows, and that Medicare Part B must pay for services ordered, certified, or referred under that provision.
Not later than 3 months after the date of enactment of this Act, the Secretary of Health and Human Services shall revise section 410.69 of title 42, Code of Federal Regulations, to clarify that, for purposes of payment under part B of title XVIII of the Social Security Act— (1) certified registered nurse anesthetists are authorized to order, certify, and refer services to the extent allowed under the law of the State in which the services are furnished; and (2) payment shall be made under such part for such services so ordered, certified, or referred by certified registered nurse anesthetists.
Section 203 would add student registered nurse anesthetists alongside physician residents in an existing special payment rule for teaching. The rule’s payment amounts and conditions are not reproduced.
203. Special payment rule for teaching student registered nurse anesthetists Section 1848(a)(6) of the Social Security Act (42 U.S.C. 1395w–4(a)(6)) is amended, in the matter preceding subparagraph (A), by inserting or student registered nurse anesthetists after physician residents.
Section 204 would prohibit requiring physician supervision of certified registered nurse anesthetists under the Medicare provision being amended. It would separately add language specifying anesthesiologist supervision for anesthesiologist assistants.
(1) in the second sentence, by inserting , but may not require that certified registered nurse anesthetists provide services under the supervision of a physician after certification of nurse anesthetists; and (2) in the third sentence, by inserting under the supervision of an anesthesiologist after an anesthesiologist assistant.
Section 205 would make certified registered nurse anesthetist services a required Medicaid benefit when the professional is authorized to perform them under state law. It would also require payment amounts no lower than those under the referenced Medicare payment provision, using the same methodology. The bill does not reproduce that methodology or state a dollar amount.
205. CRNA services as a Medicaid-required benefit
services furnished by a certified registered nurse anesthetist (as defined in section 1861(bb)(2)), which such certified registered nurse anesthetist is authorized to perform under State law (or the State regulatory mechanism as provided by State law)
provide for payment for the services of a certified registered nurse anesthetist (as defined in section 1861(bb)(1)) in amounts no lower than the amounts, using the same methodology, used for payment for amounts under section 1833(a)(1)(H).
Section 301 would include certain services by interns or residents supervised by certified nurse-midwives in Medicare’s nurse-midwife service definition. The services must fall within the nurse-midwife’s state-law authority, otherwise qualify as nurse-midwife services, and otherwise be covered if provided by a physician or under physician supervision.
(B) such services (and such supplies and services furnished as an incident to the nurse-midwife's service) which— (i) the certified nurse-midwife is legally authorized to perform under State law (or the State regulatory mechanism provided by State law) as would otherwise be covered if furnished by a physician; (ii) are furnished under the supervision of a certified-nurse midwife by an intern or resident-in-training (as described in subsection (b)(6)); (iii) would otherwise be described in subparagraph (A) if furnished by a certified nurse-midwife; and (iv) would otherwise be covered if furnished under the supervision of a physician.
Section 301 would also expressly include clinical training in an existing Public Health Service Act grant provision. This amendment does not specify a new funding amount.
(b) Clarifying permissibility of using certain grants for clinical training by certified nurse-Midwives Section 811(a)(1) of the Public Health Service Act (42 U.S.C. 296j(a)(1)) is amended by inserting , including clinical training, after projects.
Section 302 would add certified nurse-midwives to specified Medicare home-health provisions and make related changes in section 1895 of the Social Security Act. The existing statutory language is not reproduced in full, limiting what the bundle establishes about the detailed requirements.
302. Improving Medicare patient access to home health services provided by certified nurse-midwives
by inserting or a certified nurse-midwife (as defined in section 1861(gg)), after or a physician assistant (as defined in section 1861(aa)(5)) who is working in accordance with State law,
(b) Conforming amendments Section 1895 of the Social Security Act (42 U.S.C. 1395(fff)) is amended— (1) in subsection (c)(1), by inserting the certified nurse-midwife (as defined in section 1861(gg)), after clinical nurse specialist (as those terms are defined in section 1861(aa)(5)),; and (2) in subsection (e)(1)(A), by striking a physician a nurse practitioner or clinical nurse specialist, and inserting a physician, a nurse practitioner, a clinical nurse specialist, a certified nurse-midwife,.
Section 303 would add certified nurse-midwives to two specified Medicare equipment-related provisions and update a related practitioner reference. The supplied amendments do not reproduce the underlying service and payment requirements.
Section 1834(a) of the Social Security Act (42 U.S.C. 1395m(a)) is amended— (1) in paragraph (1)(E)(ii) by striking or a clinical nurse specialist (as those terms are defined in section 1861(aa)(5)) and inserting , a clinical nurse specialist (as those terms are defined in section 1861(aa)(5)), or a certified nurse-midwife (as defined in section 1861(gg)); and (2) in paragraph (11)(B)(ii)— (A) by striking or a clinical nurse specialist (as those terms are defined in section 1861(aa)(5)) and inserting a clinical nurse specialist (as those terms are defined in section 1861(aa)(5)), or a certified nurse-midwife (as defined in section 1861(gg)); and (B) by striking or specialist and inserting specialist, or nurse-midwife.
Section 304 would replace an alternative certification clause referring to an organization recognized by the Secretary with a requirement for certification by the American Midwifery Certification Board or a successor organization. It changes “or” to “and”; the other qualification language is not reproduced.
Section 1861(gg)(2) of the Social Security Act (42 U.S.C. 1395x(gg)(2)) is amended by striking , or has been certified by an organization recognized by the Secretary and inserting and has been certified by the American Midwifery Certification Board (or a successor organization).
Section 401 would expand disclosures for Medicare contractors’ local coverage decisions. Contractors would have to identify medical or scientific experts consulted, even if their advice was not used, and provide links to written communications and rules, guidelines, protocols, or other criteria relied upon.
(vi) Identification of any medical or scientific experts whose advice was obtained by such contractor during the development of such determination, whether or not such contractor relied on such advice in developing such determination. (vii) A hyperlink to any written communication between such contractor and another entity that such contractor relied on when developing such determination. (viii) A hyperlink to any rule, guideline, protocol, or other criterion that such contractor relied on when developing such determination.
Section 401 would direct the Secretary to prohibit practitioner-qualification coverage limits through local coverage decisions for the physicians and practitioners referenced in the provision. Contractors could face a civil monetary penalty of up to $10,000 for each failure to comply with that prohibition or the required disclosures. The provision incorporates an existing statutory penalty framework.
(E) Prohibition on imposition of practitioner qualifications The Secretary shall prohibit a Medicare administrative contractor that develops a local coverage determination from imposing such determination on any coverage limitation with respect to the qualifications of a physician (as defined in section 1861(r)) or a practitioner described in section 1842(b)(18)(C) who may furnish the item or service that is the subject of such determination.
A Medicare administrative contractor that develops a local coverage determination that fails to make information described in subparagraph (D) available as required by the Secretary under such subparagraph or comply with the prohibition under subparagraph (E) is subject to a civil monetary penalty of not more than $10,000 for each such failure. The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under the previous sentence in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).
Section 401 would allow an aggrieved party to challenge a local coverage decision once it is posted on the contractor’s website, even before it takes effect. The section’s amendments would apply to decisions made available on the contractor and Medicare websites on or after enactment.
An aggrieved party may file a complaint described in subparagraph (A) with respect to a local coverage determination on or after the date that such determination is posted, in accordance with section 1862(l)(5)(D), on the Internet website of the Medicare administrative contractor making such determination, whether or not such determination has taken effect.
The amendments made by this section shall apply to local coverage determinations made available on the internet website of a Medicare administrative contractor and on the Medicare internet website on or after the date of the enactment of this Act.
Section 402 concerns temporary substitute practitioners, commonly called locum tenens. It would extend the referenced physician-services rule to certified registered nurse anesthetists, nurse practitioners, clinical nurse specialists, and certified nurse-midwives on the same terms. The underlying rule and its limits are not reproduced.
402. Locum tenens
(K) in the case of services furnished by a certified registered nurse anesthetist (as defined in section 1861(bb)(2)), nurse practitioner, or clinical nurse specialist (as defined in section 1861(aa)(5)), or a certified nurse midwife (as defined in section 1861(gg)(2)), subparagraph (D) of this sentence shall apply to such services and such anesthetist, practitioner, specialist, or nurse-midwife in the same manner as such subparagraph applies to physicians’ services furnished by physicians.
Except for sections 103 and 401, the bill would apply to items and services furnished starting 90 days after enactment. The Secretary would have to use an interim final rule or agency guidance if the Secretary determines that approach is necessary to meet this or another effective date in the bill.
The provisions of, including the amendments made by, this Act (other than sections 103 and 401) shall apply with respect to items and services furnished on or after the date that is 90 days after the date of the enactment of this Act.
Notwithstanding any other provision of law, the Secretary of Health and Human Services shall implement such provisions, including such amendments, through interim final rule or subregulatory guidance if the Secretary determines such implementation to be necessary for purposes of complying with the preceding sentence or with any other effective date provided in this Act.
The supplied action snapshot, updated September 19, 2026, records introduction in the House and referral to the Energy and Commerce and Ways and Means committees on February 13, 2025. It does not establish what happened beyond the actions supplied.
Source snapshot updated 2026-09-19T23:31:50Z.
2025-02-13: 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.
2025-02-13: Introduced in House
A closer look
Reviewed version: Introduced in House · 2025-02-13. These findings describe provisions and who may benefit; they are not judgments of waste, corruption, or motive.
This review covers the supplied bill text. “None identified” does not rule out provisions in later versions or accompanying reports and disclosures.
Provisions outside the bill’s main subject, or policy changes attached to appropriations.
None identified in the reviewed text
No unrelated provision or policy rider attached to appropriations was identified in the complete supplied introduced text. This conclusion does not establish the absence of riders in other versions or accompanying materials.
Spending directed to particular recipients or places outside ordinary competitive or formula-based allocation.
None identified in the reviewed text
No congressionally directed spending for a particular recipient or place was identified in the complete supplied introduced text. This conclusion is limited to that version and does not establish formal earmark status in accompanying materials.
Narrow exceptions, exemptions, or preferential treatment that warrant a closer look.
Findings to examine
A named-organization certification requirement warrants scrutiny as narrow preferential treatment. This classification does not establish improper motive or financial gain.
Section 304 would give the American Midwifery Certification Board, or a successor organization, a specifically designated certification role for qualifying certified nurse-midwives. It replaces an alternative involving an organization recognized by the Secretary with a requirement naming that board. This is a narrow organizational preference within the bill’s broader changes to nurse-midwife practice.
Section 1861(gg)(2) of the Social Security Act (42 U.S.C. 1395x(gg)(2)) is amended by striking , or has been certified by an organization recognized by the Secretary and inserting and has been certified by the American Midwifery Certification Board (or a successor organization).
Full text preserved for this analysis. Legislative record snapshot: Sep 19, 2026. How PlainBill uses AI