S. 575 — I CAN Act

This section expands Medicare coverage for cardiac rehabilitation programs (i.e., supervised exercise, education, and risk factor modification for beneficiaries post-heart attack, surgery, or with stable angina) and pulmonary rehabilitation programs (i.e., similar services for beneficiaries with moderate-to-very severe chronic obstructive pulmonary disease) by authorizing physician assistants, nurse practitioners, or clinical nurse specialists (in addition to physicians) to prescribe exercise and provide required physician supervision. It also revises the cardiac rehabilitation program definition to authorize services in "the office setting" (from "a physician's office").

This section permits nurse practitioners and physician assistants, in addition to physicians, to provide the documentation required under Medicare Part B for coverage of therapeutic shoes (i.e., depth shoes, custom-molded shoes, and inserts) for individuals with diabetes. (As background, this benefit covers one pair of shoes and three pairs of inserts per calendar year for diabetics at risk of amputation due to peripheral neuropathy or history of foot ulcers.)

This section revises beneficiary assignment criteria under the Medicare Shared Savings Program by adding, for performance years beginning on or after January 1, 2026, primary care services furnished under Medicare parts A and B by accountable care organization (ACO) practitioners described in subsection (h)(1)(B) (i.e., nurse practitioners, clinical nurse specialists, certified nurse-midwives, and physician assistants). (As background, the program assigns Medicare fee-for-service beneficiaries prospectively to ACOs based primarily on their plurality of primary care services, enabling ACOs to manage care and qualify for shared savings if they meet quality and cost benchmarks.)

This section expands the definition of medical nutrition therapy (MNT) services under Medicare Part B to include those furnished by a nurse practitioner, clinical nurse specialist, or physician assistant (as defined in 42 U.S.C. 1395x(aa)(5)), in addition to a registered dietitian or nutrition professional. (As background, MNT services provide nutritional assessment, diagnosis, counseling, and intervention to Medicare beneficiaries with diabetes or chronic kidney disease.)

This section revises Medicare home infusion therapy requirements—services that supply nursing, patient training, and remote monitoring for administration of certain parenteral drugs and biologicals (e.g., chemotherapy, antibiotics) in the home—to permit applicable providers (i.e., physicians, nurse practitioners, clinical nurse specialists, or physician assistants, as defined in SSA 1861(iii)(3)(A)) rather than only physicians (as defined in SSA 1861(r)(1)) to establish initial plans of care and make certifications for payment.

This section expands the role of nurse practitioners in Medicare hospice care by (1) revising certification requirements in SSA §1814(a)(7)(A) to authorize nurse practitioners to certify eligibility in additional cases previously limited to physicians; (2) amending the definition of hospice care in SSA §1861(dd)(1)(C) to include certification by a nurse practitioner; and (3) directing the Secretary of Health and Human Services, within 90 days of enactment, to revise regulations at 42 CFR §418.304 to allow nurse practitioners to bill for services not covered under paragraph (a)—as physicians do under paragraph (b)—at the percentage of the physician fee schedule specified in SSA §1833(a)(1)(O). (Hospice care provides Medicare coverage for terminally ill beneficiaries needing palliative and supportive care.)

This section expands the authority of nurse practitioners (NPs) to certify, supervise, and provide care under Medicare Part A for post-hospital extended care services in skilled nursing facilities (SNFs), inpatient hospital services, and related services (previously limited primarily to physicians, with NPs in some cases requiring physician collaboration). Specifically, it (1) authorizes NPs (in accordance with State law) to certify the need for post-hospital SNF services under SSA §1814(a)(2); (2) permits NPs to perform certifications under SSA §1814(a)(3); (3) allows NPs (in accordance with State law) to supervise resident care and serve as attending providers in Medicare SNFs under SSA §1819; (4) recognizes NPs for Part B drug administration billing under SSA §1842(b)(2)(C) without requiring physician collaboration; (5) clarifies NP and clinical nurse specialist roles in SNF physician services under SSA §1861(s)(2)(K)(ii); and (6) adds NPs to services covered under SSA §1861(e), (f), and (ee) for SNFs and swing-bed hospitals. This section makes parallel changes for Medicaid by (1) authorizing NPs (or clinical nurse specialists working with physicians, for certain services) to certify admissions and recertify care needs for inpatient hospital, SNF, intermediate care facility, and inpatient mental hospital services under SSA §1902(a)(44), and to establish/review care plans; and (2) permitting NPs (or, at State option, clinical nurse specialists or physician assistants working with physicians) to supervise nursing facility resident care under SSA §1919(b)(6)(A). (Thus, these changes enable NPs—who provide primary care in underserved areas—to assume roles traditionally held by physicians, potentially improving access to care in long-term care facilities.)

This section directs the Secretary of Health and Human Services, not later than three months after the date of enactment, to revise Medicare regulations (42 CFR 410.69) to clarify that certified registered nurse anesthetists (CRNAs) may order, certify, and refer services to the extent allowed under state law where the services are furnished and that Medicare Part B will pay for such services. (Thus, this expands Medicare Part B payment eligibility—currently limited to certain providers—for services ordered, certified, or referred by CRNAs in states authorizing such practice.)

This section expands the special payment rule under the Medicare physician fee schedule (Part B) to include services attributable to student registered nurse anesthetists, in addition to physician residents, in teaching hospitals (or critical access hospitals). (As background, the rule requires that payments for such services be determined without regard to budget neutrality reductions under the fee schedule and subject to Secretary rules; thus, the change ensures equivalent payment protections for student registered nurse anesthetists training to become certified registered nurse anesthetists.)

This section amends the Medicare definition of certified registered nurse anesthetist (CRNA) services to (1) prohibit any requirement that CRNAs provide such services under the supervision of a physician and (2) require anesthesiologist assistants to provide services under the supervision of an anesthesiologist. (Thus, CRNAs—advanced practice nurses who administer anesthesia and are reimbursed under Medicare Part B—may practice independently for Medicare-covered services, while tightening supervision standards for anesthesiologist assistants.)

This section requires state Medicaid programs to cover, as a mandatory benefit, services furnished by a certified registered nurse anesthetist (CRNA)—as defined in SSA section 1861(bb)(2) and authorized under state law. It further requires Medicaid payment for CRNA services (as defined in SSA section 1861(bb)(1)) at amounts no lower than, and using the same methodology as, Medicare payments under SSA section 1833(a)(1)(H).

This section revises the definition of certified nurse-midwife services under Medicare Part B to include services (and related supplies) furnished by an intern or resident-in-training under certified nurse-midwife supervision, if legally authorized by the certified nurse-midwife under state law and otherwise covered as physician services or under physician supervision. (Thus, Medicare pays for such resident training in maternity care, which was previously excluded.) It also clarifies that grants under the advanced nurse education program (sec. 811 of the Public Health Service Act) may be used for projects, including clinical training.

This section authorizes certified nurse-midwives (as defined in SSA §1861(gg)) to certify Medicare beneficiaries' need for home health services, periodically review and approve plans of care, and perform related functions previously limited to physicians, physician assistants (as defined in SSA §1861(aa)(5)), nurse practitioners, and clinical nurse specialists. It makes conforming changes to the home health prospective payment system (HH PPS) requirements for plan establishment and certification. (As background, Medicare home health services—provided to approximately 12 million beneficiaries annually under Parts A and B—require certification of medical necessity and an individualized plan of care.)

This section expands the list of practitioners authorized to conduct face-to-face examinations of Medicare beneficiaries and issue prescriptions for covered durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)—currently limited to physicians, physician assistants, nurse practitioners, and clinical nurse specialists—to also include certified nurse-midwives. The section makes this change in two provisions: the general standards for clinical conditions for DMEPOS payment (para. (1)(E)(ii)) and the requirements applicable to certain items subject to those standards (para. (11)(B)(ii)).

This section revises the qualifications for certified nurse-midwives whose services are covered under Medicare Part B by requiring both state legal authorization to practice as a nurse-midwife and certification by the American Midwifery Certification Board (or successor organization), replacing the prior alternative of state authorization or certification by a Secretary-recognized organization.

This section revises the local coverage determination (LCD) process under Medicare, which allows Medicare Administrative Contractors (MACs) to determine coverage of items and services in their jurisdictions. Specifically, it (1) requires LCDs to identify any medical or scientific experts consulted (whether relied upon or not) and provide hyperlinks to written communications and criteria (e.g., rules, guidelines) relied upon; (2) prohibits MACs from imposing coverage limitations based on the qualifications of physicians or certain practitioners; (3) subjects MACs to civil monetary penalties of up to $10,000 for each failure to disclose required information or comply with the prohibition; and (4) permits aggrieved parties to challenge an LCD upon its posting on the MAC's website, regardless of whether it has taken effect. The amendments apply to LCDs posted on MAC or Medicare websites on or after the date of enactment.

This section extends Medicare Part B locum tenens payment provisions—under which a substitute provider may bill under the regular provider's number during temporary absences—to services furnished by certified registered nurse anesthetists (as defined in SSA section 1861(bb)(2)), nurse practitioners or clinical nurse specialists (as defined in SSA section 1861(aa)(5)), and certified nurse-midwives (as defined in SSA section 1861(gg)(2)). (Thus, these non-physician providers receive the same substitute billing flexibility currently available to physicians.)

This section establishes that the provisions of this Act, excluding sections 103 and 401, apply to items and services furnished on or after 90 days after the date of enactment. The section further directs the Secretary of Health and Human Services to implement such provisions through interim final rules or subregulatory guidance, if necessary, to comply with that effective date or any other effective date in the Act.