Us Congress 2025-2026 Regular Session

Us Congress House Bill HB1317 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	I
2	2	119THCONGRESS
3	3	1
4	4	STSESSION H. R. 1317
5	5	To amend titles XVIII and XIX of the Social Security Act to increase
6	6	access to services provided by advanced practice registered nurses under
7	7	the Medicare and Medicaid programs, and for other purposes.
8	8	IN THE HOUSE OF REPRESENTATIVES
9	9	FEBRUARY13, 2025
10	10	Mr. J
11	11	OYCEof Ohio (for himself, Ms. BONAMICI, Mrs. KIGGANSof Virginia,
12	12	Ms. U
13	13	NDERWOOD, and Mr. ROGERSof Alabama) introduced the following
14	14	bill; which was referred to the Committee on Energy and Commerce, and
15	15	in addition to the Committee on Ways and Means, for a period to be sub-
16	16	sequently determined by the Speaker, in each case for consideration of
17	17	such provisions as fall within the jurisdiction of the committee concerned
18	18	A BILL
19	19	To amend titles XVIII and XIX of the Social Security Act
20	20	to increase access to services provided by advanced prac-
21	21	tice registered nurses under the Medicare and Medicaid
22	22	programs, and for other purposes.
23	23	Be it enacted by the Senate and House of Representa-1
24	24	tives of the United States of America in Congress assembled, 2
25	25	SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 3
26	26	(a) S
27	27	HORTTITLE.—This Act may be cited as the 4
28	28	‘‘Improving Care and Access to Nurses Act’’ or the ‘‘I 5
29	29	CAN Act’’. 6
30	30	VerDate Sep 11 2014 00:07 Apr 09, 2025 Jkt 059200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1317.IH H1317
31	31	ssavage on LAPJG3WLY3PROD with BILLS 2
32	32	•HR 1317 IH
33	33	(b) TABLE OFCONTENTS.—The table of contents of 1
34	34	this Act is as follows: 2
35	35	Sec. 1. Short title; table of contents.
36	36	TITLE I—REMOVAL OF BARRIERS TO PRACTICE ON NURSE
37	37	PRACTITIONERS
38	38	Sec. 101. Expanding access to cardiac rehabilitation programs and pulmonary
39	39	rehabilitation programs under Medicare program.
40	40	Sec. 102. Permitting nurse practitioners and physician assistants to satisfy
41	41	Medicare documentation requirement for coverage of certain
42	42	shoes for individuals with diabetes.
43	43	Sec. 103. Improvements to the assignment of beneficiaries under the Medicare
44	44	shared savings program.
45	45	Sec. 104. Expanding the availability of medical nutrition therapy service Medi-
46	46	care program.
47	47	Sec. 105. Preserving access to home infusion therapy.
48	48	Sec. 106. Increasing access to hospice care services.
49	49	Sec. 107. Streamlining care delivery in skilled nursing facilities and nursing fa-
50	50	cilities; authorizing Medicare and Medicaid inpatient hospital
51	51	patients to be under the care of a nurse practitioner.
52	52	Sec. 108. Improving access to Medicaid clinic services.
53	53	TITLE II—REMOVAL OF BARRIERS TO PRACTICE ON CERTIFIED
54	54	REGISTERED NURSE ANESTHETISTS
55	55	Sec. 201. Clarifying that certified registered nurse anesthetists can be reim-
56	56	bursed by Medicare for evaluation and management services.
57	57	Sec. 202. Revision of conditions of payment relating to services ordered and re-
58	58	ferred by certified registered nurse anesthetists.
59	59	Sec. 203. Special payment rule for teaching student registered nurse anes-
60	60	thetists.
61	61	Sec. 204. Removing unnecessary and costly supervision of certified registered
62	62	nurse anesthetists.
63	63	Sec. 205. CRNA services as a Medicaid-required benefit.
64	64	TITLE III—REMOVAL OF BARRIERS TO PRACTICE ON CERTIFIED
65	65	NURSE-MIDWIVES
66	66	Sec. 301. Improving access to training in maternity care.
67	67	Sec. 302. Improving Medicare patient access to home health services provided
68	68	by certified nurse-midwives.
69	69	Sec. 303. Improving access to DMEPOS for Medicare beneficiaries.
70	70	Sec. 304. Technical changes to qualifications and conditions with respect to the
71	71	services of certified nurse-midwives.
72	72	TITLE IV—IMPROVING FEDERAL HEALTH PROGRAMS FOR ALL
73	73	ADVANCED PRACTICE REGISTERED NURSES
74	74	Sec. 401. Revising the local coverage determination process under the Medicare
75	75	program.
76	76	Sec. 402. Locum tenens.
77	77	VerDate Sep 11 2014 00:07 Apr 09, 2025 Jkt 059200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\H1317.IH H1317
78	78	ssavage on LAPJG3WLY3PROD with BILLS 3
79	79	•HR 1317 IH
80	80	TITLE V—EFFECTIVE DATE
81	81	Sec. 501. Effective date.
82	82	TITLE I—REMOVAL OF BAR-1
83	83	RIERS TO PRACTICE ON 2
84	84	NURSE PRACTITIONERS 3
85	85	SEC. 101. EXPANDING ACCESS TO CARDIAC REHABILITA-4
86	86	TION PROGRAMS AND PULMONARY REHA-5
87	87	BILITATION PROGRAMS UNDER MEDICARE 6
88	88	PROGRAM. 7
89	89	(a) C
90	90	ARDIACREHABILITATIONPROGRAMS.—Section 8
91	91	1861(eee) of the Social Security Act (42 U.S.C. 9
92	92	1395x(eee)) is amended— 10
93	93	(1) in paragraph (2)— 11
94	94	(A) in subparagraph (A)(i), by striking ‘‘a 12
95	95	physician’s office’’ and inserting ‘‘the office set-13
96	96	ting’’; and 14
97	97	(B) in subparagraph (C), by inserting after 15
98	98	‘‘physician’’ the following: ‘‘(as defined in sub-16
99	99	section (r)(1)) or a physician assistant, nurse 17
100	100	practitioner, or clinical nurse specialist (as 18
101	101	those terms are defined in subsection (aa)(5))’’; 19
102	102	(2) in paragraph (3)(A), by striking ‘‘physician- 20
103	103	prescribed exercise’’ and inserting ‘‘exercise pre-21
104	104	scribed by a physician (as defined in subsection 22
105	105	(r)(1)) or a physician assistant, nurse practitioner, 23
106	106	VerDate Sep 11 2014 00:07 Apr 09, 2025 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1317.IH H1317
107	107	ssavage on LAPJG3WLY3PROD with BILLS 4
108	108	•HR 1317 IH
109	109	or clinical nurse specialist (as those terms are de-1
110	110	fined in subsection (aa)(5))’’; and 2
111	111	(3) in paragraph (5), by inserting after ‘‘physi-3
112	112	cian’’ the following: ‘‘(as defined in subsection 4
113	113	(r)(1)) or a physician assistant, nurse practitioner, 5
114	114	or clinical nurse specialist (as those terms are de-6
115	115	fined in subsection (aa)(5))’’. 7
116	116	(b) P
117	117	ULMONARYREHABILITATIONPROGRAMS.—Sec-8
118	118	tion 1861(fff) of the Social Security Act (42 U.S.C. 9
119	119	1395x(fff)) is amended— 10
120	120	(1) in paragraph (2)(A), by striking ‘‘physician- 11
121	121	prescribed exercise’’ and inserting ‘‘exercise pre-12
122	122	scribed by a physician (as defined in subsection 13
123	123	(r)(1)) or a physician assistant, nurse practitioner, 14
124	124	or clinical nurse specialist (as those terms are de-15
125	125	fined in subsection (aa)(5))’’; and 16
126	126	(2) in paragraph (3), by inserting after ‘‘physi-17
127	127	cian’’ the following: ‘‘(as defined in subsection 18
128	128	(r)(1)) or a physician assistant, nurse practitioner, 19
129	129	or clinical nurse specialist (as those terms are de-20
130	130	fined in subsection (aa)(5))’’. 21
131	131	VerDate Sep 11 2014 00:07 Apr 09, 2025 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1317.IH H1317
132	132	ssavage on LAPJG3WLY3PROD with BILLS 5
133	133	•HR 1317 IH
134	134	SEC. 102. PERMITTING NURSE PRACTITIONERS AND PHYSI-1
135	135	CIAN ASSISTANTS TO SATISFY MEDICARE 2
136	136	DOCUMENTATION REQUIREMENT FOR COV-3
137	137	ERAGE OF CERTAIN SHOES FOR INDIVIDUALS 4
138	138	WITH DIABETES. 5
139	139	Section 1861(s)(12) of the Social Security Act (42 6
140	140	U.S.C. 1395x(s)(12)) is amended— 7
141	141	(1) in subparagraph (A), by inserting ‘‘, nurse 8
142	142	practitioner, or physician assistant’’ after ‘‘physi-9
143	143	cian’’; and 10
144	144	(2) in subparagraph (C), by inserting ‘‘, nurse 11
145	145	practitioner, or physician assistant’’ after each oc-12
146	146	currence of ‘‘physician’’. 13
147	147	SEC. 103. IMPROVEMENTS TO THE ASSIGNMENT OF BENE-14
148	148	FICIARIES UNDER THE MEDICARE SHARED 15
149	149	SAVINGS PROGRAM. 16
150	150	Section 1899(c)(1) of the Social Security Act (42 17
151	151	U.S.C. 1395jjj(c)(1)) is amended— 18
152	152	(1) in subparagraph (A), by striking ‘‘and’’ at 19
153	153	the end; 20
154	154	(2) in subparagraph (B), by striking the period 21
155	155	at the end and inserting ‘‘; and’’; and 22
156	156	(3) by adding at the end the following new sub-23
157	157	paragraph: 24
158	158	‘‘(C) in the case of performance years be-25
159	159	ginning on or after January 1, 2026, primary 26
160	160	VerDate Sep 11 2014 00:07 Apr 09, 2025 Jkt 059200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1317.IH H1317
161	161	ssavage on LAPJG3WLY3PROD with BILLS 6
162	162	•HR 1317 IH
163	163	care services provided under this title by an 1
164	164	ACO professional described in subsection 2
165	165	(h)(1)(B).’’. 3
166	166	SEC. 104. EXPANDING THE AVAILABILITY OF MEDICAL NU-4
167	167	TRITION THERAPY SERVICE MEDICARE PRO-5
168	168	GRAM. 6
169	169	Section 1861(vv)(1) of the Social Security Act (42 7
170	170	U.S.C. 1395x(vv)(1)) is amended by inserting ‘‘ or a nurse 8
171	171	practitioner, a clinical nurse specialist, or a physician as-9
172	172	sistant (as such terms are defined in subsection (aa)(5))’’ 10
173	173	before the period at the end. 11
174	174	SEC. 105. PRESERVING ACCESS TO HOME INFUSION THER-12
175	175	APY. 13
176	176	(a) A
177	177	LLOWINGAPPLICABLEPROVIDERSTOESTAB-14
178	178	LISHHOMEINFUSIONTHERAPY PLANS.—Section 15
179	179	1861(iii)(1)(B) of the Social Security Act (42 U.S.C. 16
180	180	1395x(iii)(1)(B)) is amended— 17
181	181	(1) by striking ‘‘a physician (as defined in sub-18
182	182	section (r)(1))’’ and inserting ‘‘an applicable pro-19
183	183	vider (as defined in paragraph (3)(A))’’; and 20
184	184	(2) by striking ‘‘a physician (as so defined)’’ 21
185	185	and inserting ‘‘an applicable provider (as so de-22
186	186	fined)’’. 23
187	187	(b) C
188	188	ONFORMINGAMENDMENT.—Section 1834(u)(6) 24
189	189	of the Social Security Act (42 U.S.C. 1395m(u)(6)) is 25
190	190	VerDate Sep 11 2014 00:07 Apr 09, 2025 Jkt 059200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1317.IH H1317
191	191	ssavage on LAPJG3WLY3PROD with BILLS 7
192	192	•HR 1317 IH
193	193	amended by striking ‘‘physician’’ and inserting ‘‘applicable 1
194	194	provider (as defined in section 1861(iii)(3)(A))’’. 2
195	195	SEC. 106. INCREASING ACCESS TO HOSPICE CARE SERV-3
196	196	ICES. 4
197	197	(a) I
198	198	NGENERAL.—Section 1814(a)(7)(A) of the So-5
199	199	cial Security Act (42 U.S.C. 1395f(a)(7)(A)) is amend-6
200	200	ed— 7
201	201	(1) in clause (i)— 8
202	202	(A) in subclause (I), by striking ‘‘a nurse 9
203	203	practitioner or’’; 10
204	204	(B) in subclause (II), by inserting ‘‘or 11
205	205	nurse practitioner’’ after ‘‘physician’’; and 12
206	206	(C) in the flush matter following subclause 13
207	207	(II), by inserting ‘‘, nurse practitioner’s,’’ after 14
208	208	‘‘physician’s’’; and 15
209	209	(2) in clause (ii), by striking ‘‘or physician’’ and 16
210	210	inserting ‘‘, physician, or nurse practitioner’’. 17
211	211	(b) H
212	212	OSPICE CARE DEFINITION.—Section 18
213	213	1861(dd)(1)(C) of the Social Security Act (42 U.S.C. 19
214	214	1395x(dd)(1)(C)) is amended by inserting ‘‘or nurse prac-20
215	215	titioner’’ after ‘‘physician’’. 21
216	216	(c) N
217	217	URSEPRACTITIONERBILLING.—Not later than 22
218	218	90 days after the date of the enactment of this Act, the 23
219	219	Secretary of Health and Human Services shall revise sec-24
220	220	tion 418.304 of title 42, Code of Federal Regulations, to 25
221	221	VerDate Sep 11 2014 00:07 Apr 09, 2025 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1317.IH H1317
222	222	ssavage on LAPJG3WLY3PROD with BILLS 8
223	223	•HR 1317 IH
224	224	allow nurse practitioners to bill for services not described 1
225	225	in paragraph (a) of such section in the same manner as 2
226	226	physicians may bill for such services in accordance with 3
227	227	paragraph (b) of such section. Such revision shall provide 4
228	228	that such services furnished by a nurse practitioner shall 5
229	229	be payable at the percent of the physician fee schedule 6
230	230	specified in section 1833(a)(1)(O) of the Social Security 7
231	231	Act (42 U.S.C. 1395l(a)(1)(O)). 8
232	232	SEC. 107. STREAMLINING CARE DELIVERY IN SKILLED 9
233	233	NURSING FACILITIES AND NURSING FACILI-10
234	234	TIES; AUTHORIZING MEDICARE AND MED-11
235	235	ICAID INPATIENT HOSPITAL PATIENTS TO BE 12
236	236	UNDER THE CARE OF A NURSE PRACTI-13
237	237	TIONER. 14
238	238	(a) M
239	239	EDICARE.— 15
240	240	(1) C
241	241	ERTIFICATION OF POST -HOSPITAL EX-16
242	242	TENDED CARE SERVICES .—Section 1814(a)(2) of the 17
243	243	Social Security Act (42 U.S.C. 1395f(a)(2)) is 18
244	244	amended, in the matter preceding subparagraph (A), 19
245	245	by striking ‘‘, or a nurse practitioner,’’ and inserting 20
246	246	‘‘or a nurse practitioner (in accordance with State 21
247	247	law), or’’. 22
248	248	(2) C
249	249	ERTIFICATION AUTHORITY FOR NURSE 23
250	250	PRACTITIONERS.—Section 1814(a)(3) of the Social 24
251	251	VerDate Sep 11 2014 00:07 Apr 09, 2025 Jkt 059200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1317.IH H1317
252	252	ssavage on LAPJG3WLY3PROD with BILLS 9
253	253	•HR 1317 IH
254	254	Security Act (42 U.S.C. 1395f(a)(3)) is amended by 1
255	255	inserting ‘‘or nurse practitioner’’ after ‘‘physician’’. 2
256	256	(3) S
257	257	UPERVISION REQUIREMENT IN SKILLED 3
258	258	NURSING FACILITY SERVICES AND RESIDENT ’S 4
259	259	RIGHTS.—Section 1819 of the Social Security Act 5
260	260	(42 U.S.C. 1395i–3(b)(6)) is amended— 6
261	261	(A) in subsection (b)— 7
262	262	(i) in paragraph (2)(B), by inserting 8
263	263	‘‘or nurse practitioner’’ after ‘‘attending 9
264	264	physician’’; and 10
265	265	(ii) in paragraph (6)— 11
266	266	(I) in the heading, by striking 12
267	267	‘‘P
268	268	HYSICIAN SUPERVISION ’’ and in-13
269	269	serting ‘‘S
270	270	UPERVISION’’; and 14
271	271	(II) in subparagraph (A), by in-15
272	272	serting ‘‘or a nurse practitioner, in ac-16
273	273	cordance with State law’’ after ‘‘physi-17
274	274	cian’’; and 18
275	275	(B) in subsection (c)— 19
276	276	(i) in subparagraph (1)(A)(i), by in-20
277	277	serting ‘‘or nurse practitioner’’ after ‘‘at-21
278	278	tending physician’’; 22
279	279	(ii) in the flush matter at the end of 23
280	280	subparagraph (2)(A), by inserting ‘‘or 24
281	281	VerDate Sep 11 2014 00:07 Apr 09, 2025 Jkt 059200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1317.IH H1317
282	282	ssavage on LAPJG3WLY3PROD with BILLS 10
283	283	•HR 1317 IH
284	284	nurse practitioner’’ after ‘‘physician’’ in 1
285	285	each occurrence; and 2
286	286	(iii) in subparagraph (3)(A), by in-3
287	287	serting ‘‘or nurse practitioner’’ after ‘‘phy-4
288	288	sician’’. 5
289	289	(4) A
290	290	DMINISTRATION OF PART B .—Section 6
291	291	1842(b)(2)(C) of the Social Security Act (42 U.S.C. 7
292	292	1395u(b)(2)(C)) is amended, in the second sen-8
293	293	tence— 9
294	294	(A) by inserting ‘‘or a nurse practitioner’’ 10
295	295	after ‘‘a physician’’; and 11
296	296	(B) by striking ‘‘or a nurse practitioner 12
297	297	working in collaboration with that physician, or 13
298	298	both’’. 14
299	299	(5) P
300	300	ROVISION OF MEDICAL AND OTHER 15
301	301	HEALTH SERVICES .—Section 1861(s)(2)(K)(ii) of 16
302	302	the Social Security Act (42 U.S.C. 17
303	303	1395x(s)(2)(K)(ii)) is amended by striking ‘‘or clin-18
304	304	ical nurse specialist (as defined in subsection 19
305	305	(aa)(5)) working in collaboration (as defined in sub-20
306	306	section (aa)(6)) with a physician (as defined in sub-21
307	307	section (r)(1))’’ and inserting ‘‘(as defined in sub-22
308	308	section (aa)(5)(A)), or by a clinical nurse specialist 23
309	309	(as defined in subsection (aa)(5)(B)) working in col-24
310	310	VerDate Sep 11 2014 00:07 Apr 09, 2025 Jkt 059200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1317.IH H1317
311	311	ssavage on LAPJG3WLY3PROD with BILLS 11
312	312	•HR 1317 IH
313	313	laboration with a physician (as defined in subsection 1
314	314	(r)(1)),’’. 2
315	315	(6) P
316	316	RIVILEGES FOR NURSE PRACTITIONERS .— 3
317	317	Section 1861 of the Social Security Act (42 U.S.C. 4
318	318	1395x) is amended— 5
319	319	(A) in subsection (e)(4), by inserting ‘‘(or 6
320	320	nurse practitioner, in accordance with State 7
321	321	law)’’ after ‘‘physician’’; 8
322	322	(B) in subsection (f)(1), by inserting ‘‘or 9
323	323	nurse practitioner’’ after ‘‘physician’’; and 10
324	324	(C) in each of subparagraphs (B) and (F) 11
325	325	of subsection (ee)(2), by inserting ‘‘or nurse 12
326	326	practitioner’’ after ‘‘physician’’. 13
327	327	(b) M
328	328	EDICAID.— 14
329	329	(1) C
330	330	ERTIFICATION AUTHORITY FOR NURSE 15
331	331	PRACTITIONERS.—Section 1902(a)(44) of the Social 16
332	332	Security Act (42 U.S.C. 1396a(a)(44)) is amended 17
333	333	to read as follows: 18
334	334	‘‘(44) in each case for which payment for inpa-19
335	335	tient hospital services, skilled nursing facility serv-20
336	336	ices, services in an intermediate care facility de-21
337	337	scribed in section 1905(d), or inpatient mental hos-22
338	338	pital services is made under the State plan— 23
339	339	‘‘(A) a physician or nurse practitioner (or, 24
340	340	in the case of skilled nursing facility services or 25
341	341	VerDate Sep 11 2014 00:07 Apr 09, 2025 Jkt 059200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H1317.IH H1317
342	342	ssavage on LAPJG3WLY3PROD with BILLS 12
343	343	•HR 1317 IH
344	344	intermediate care facility services, a physician 1
345	345	or nurse practitioner, or a clinical nurse spe-2
346	346	cialist who is not an employee of the facility but 3
347	347	is working in collaboration with a physician) 4
348	348	certifies at the time of admission, or, if later, 5
349	349	the time the individual applies for medical as-6
350	350	sistance under the State plan (and a physician 7
351	351	or nurse practitioner, or a physician assistant 8
352	352	under the supervision of a physician, or, in the 9
353	353	case of skilled nursing facility services or inter-10
354	354	mediate care facility services, a physician or 11
355	355	nurse practitioner, or a clinical nurse specialist 12
356	356	who is not an employee of the facility but is 13
357	357	working in collaboration with a physician, recer-14
358	358	tifies, where such services are furnished over a 15
359	359	period of time, in such cases, at least as often 16
360	360	as required under section 1903(g)(6) (or, in the 17
361	361	case of services that are services provided in an 18
362	362	intermediate care facility, every year), and ac-19
363	363	companied by such supporting material, appro-20
364	364	priate to the case involved, as may be provided 21
365	365	in regulations of the Secretary), that such serv-22
366	366	ices are or were required to be given on an in-23
367	367	patient basis because the individual needs or 24
368	368	needed such services, and 25
369	369	VerDate Sep 11 2014 00:07 Apr 09, 2025 Jkt 059200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H1317.IH H1317
370	370	ssavage on LAPJG3WLY3PROD with BILLS 13
371	371	•HR 1317 IH
372	372	‘‘(B) such services were furnished under a 1
373	373	plan established and periodically reviewed and 2
374	374	evaluated by a physician or nurse practitioner, 3
375	375	or, in the case of skilled nursing facility services 4
376	376	or intermediate care facility services, by a phy-5
377	377	sician or nurse practitioner, or a clinical nurse 6
378	378	specialist who is not an employee of the facility 7
379	379	but is working in collaboration with a physi-8
380	380	cian;’’. 9
381	381	(2) N
382	382	URSING FACILITY SERVICES SUPERVISION 10
383	383	AND CLINICAL RECORDS .—Section 1919(b)(6)(A) of 11
384	384	the Social Security Act (42 U.S.C. 1396r(b)(6)(A)) 12
385	385	is amended to read as follows: 13
386	386	‘‘(A) require that the health care of every 14
387	387	resident be provided under the supervision of a 15
388	388	physician or nurse practitioner (or, at the op-16
389	389	tion of a State, under the supervision of a clin-17
390	390	ical nurse specialist or physician assistant who 18
391	391	is not an employee of the facility but who is 19
392	392	working in collaboration with a physician);’’. 20
393	393	SEC. 108. IMPROVING ACCESS TO MEDICAID CLINIC SERV-21
394	394	ICES. 22
395	395	Section 1905(a)(9) of the Social Security Act (42 23
396	396	U.S.C. 1396d(a)(9)) is amended by adding ‘‘or nurse 24
397	397	VerDate Sep 11 2014 00:07 Apr 09, 2025 Jkt 059200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H1317.IH H1317
398	398	ssavage on LAPJG3WLY3PROD with BILLS 14
399	399	•HR 1317 IH
400	400	practitioner’’ after ‘‘physician’’ in both places that it ap-1
401	401	pears. 2
402	402	TITLE II—REMOVAL OF BAR-3
403	403	RIERS TO PRACTICE ON CER-4
404	404	TIFIED REGISTERED NURSE 5
405	405	ANESTHETISTS 6
406	406	SEC. 201. CLARIFYING THAT CERTIFIED REGISTERED 7
407	407	NURSE ANESTHETISTS CAN BE REIMBURSED 8
408	408	BY MEDICARE FOR EVALUATION AND MAN-9
409	409	AGEMENT SERVICES. 10
410	410	Section 1861(bb)(1) of the Social Security Act (42 11
411	411	U.S.C. 1395x(bb)(1)) is amended by inserting ‘‘, including 12
412	412	pre-anesthesia evaluation and management services,’’ 13
413	413	after ‘‘and related care’’. 14
414	414	SEC. 202. REVISION OF CONDITIONS OF PAYMENT RELAT-15
415	415	ING TO SERVICES ORDERED AND REFERRED 16
416	416	BY CERTIFIED REGISTERED NURSE ANES-17
417	417	THETISTS. 18
418	418	Not later than 3 months after the date of enactment 19
419	419	of this Act, the Secretary of Health and Human Services 20
420	420	shall revise section 410.69 of title 42, Code of Federal 21
421	421	Regulations, to clarify that, for purposes of payment 22
422	422	under part B of title XVIII of the Social Security Act— 23
423	423	(1) certified registered nurse anesthetists are 24
424	424	authorized to order, certify, and refer services to the 25
425	425	VerDate Sep 11 2014 00:07 Apr 09, 2025 Jkt 059200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H1317.IH H1317
426	426	ssavage on LAPJG3WLY3PROD with BILLS 15
427	427	•HR 1317 IH
428	428	extent allowed under the law of the State in which 1
429	429	the services are furnished; and 2
430	430	(2) payment shall be made under such part for 3
431	431	such services so ordered, certified, or referred by 4
432	432	certified registered nurse anesthetists. 5
433	433	SEC. 203. SPECIAL PAYMENT RULE FOR TEACHING STU-6
434	434	DENT REGISTERED NURSE ANESTHETISTS. 7
435	435	Section 1848(a)(6) of the Social Security Act (42 8
436	436	U.S.C. 1395w–4(a)(6)) is amended, in the matter pre-9
437	437	ceding subparagraph (A), by inserting ‘‘or student reg-10
438	438	istered nurse anesthetists’’ after ‘‘physician residents’’. 11
439	439	SEC. 204. REMOVING UNNECESSARY AND COSTLY SUPER-12
440	440	VISION OF CERTIFIED REGISTERED NURSE 13
441	441	ANESTHETISTS. 14
442	442	Section 1861(bb)(2) of the Social Security Act (42 15
443	443	U.S.C. 1395x(bb)(2)) is amended— 16
444	444	(1) in the second sentence, by inserting ‘‘, but 17
445	445	may not require that certified registered nurse anes-18
446	446	thetists provide services under the supervision of a 19
447	447	physician’’ after ‘‘certification of nurse anes-20
448	448	thetists’’; and 21
449	449	(2) in the third sentence, by inserting ‘‘under 22
450	450	the supervision of an anesthesiologist’’ after ‘‘an an-23
451	451	esthesiologist assistant’’. 24
452	452	VerDate Sep 11 2014 00:07 Apr 09, 2025 Jkt 059200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H1317.IH H1317
453	453	ssavage on LAPJG3WLY3PROD with BILLS 16
454	454	•HR 1317 IH
455	455	SEC. 205. CRNA SERVICES AS A MEDICAID-REQUIRED BEN-1
456	456	EFIT. 2
457	457	(a) I
458	458	NGENERAL.—Section 1905(a)(5) of the Social 3
459	459	Security Act (42 U.S.C. 1396d(a)(5)) is amended— 4
460	460	(1) by striking ‘‘and (B)’’ and inserting ‘‘(B)’’; 5
461	461	and 6
462	462	(2) by inserting before the semicolon at the end 7
463	463	the following: ‘‘, and (C) services furnished by a cer-8
464	464	tified registered nurse anesthetist (as defined in sec-9
465	465	tion 1861(bb)(2)), which such certified registered 10
466	466	nurse anesthetist is authorized to perform under 11
467	467	State law (or the State regulatory mechanism as 12
468	468	provided by State law)’’. 13
469	469	(b) P
470	470	AYMENT.—Section 1902(a) of the Social Secu-14
471	471	rity Act (42 U.S.C. 1396d(a)) is amended— 15
472	472	(1) in paragraph (86), by striking ‘‘and’’ at the 16
473	473	end; 17
474	474	(2) in paragraph (87), by striking the period 18
475	475	and inserting ‘‘; and’’; and 19
476	476	(3) by inserting after paragraph (87) the fol-20
477	477	lowing new paragraph: 21
478	478	‘‘(88) provide for payment for the services of a 22
479	479	certified registered nurse anesthetist (as defined in 23
480	480	section 1861(bb)(1)) in amounts no lower than the 24
481	481	amounts, using the same methodology, used for pay-25
482	482	ment for amounts under section 1833(a)(1)(H).’’. 26
483	483	VerDate Sep 11 2014 00:07 Apr 09, 2025 Jkt 059200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H1317.IH H1317
484	484	ssavage on LAPJG3WLY3PROD with BILLS 17
485	485	•HR 1317 IH
486	486	TITLE III—REMOVAL OF BAR-1
487	487	RIERS TO PRACTICE ON CER-2
488	488	TIFIED NURSE-MIDWIVES 3
489	489	SEC. 301. IMPROVING ACCESS TO TRAINING IN MATERNITY 4
490	490	CARE. 5
491	491	(a) M
492	492	EDICAREPAYMENTS FOR SUPERVISION BY 6
493	493	C
494	494	ERTIFIEDNURSE-MIDWIVES.—Paragraph (1) of section 7
495	495	1861(gg) of the Social Security Act (42 U.S.C. 1395x(gg)) 8
496	496	is amended to read as follows: 9
497	497	‘‘(1) The term ‘certified nurse-midwife services’ 10
498	498	means— 11
499	499	‘‘(A) such services furnished by a certified 12
500	500	nurse-midwife (as defined in paragraph (2)); 13
501	501	and 14
502	502	‘‘(B) such services (and such supplies and 15
503	503	services furnished as an incident to the nurse- 16
504	504	midwife’s service) which— 17
505	505	‘‘(i) the certified nurse-midwife is le-18
506	506	gally authorized to perform under State 19
507	507	law (or the State regulatory mechanism 20
508	508	provided by State law) as would otherwise 21
509	509	be covered if furnished by a physician; 22
510	510	‘‘(ii) are furnished under the super-23
511	511	vision of a certified-nurse midwife by an 24
512	512	VerDate Sep 11 2014 00:07 Apr 09, 2025 Jkt 059200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H1317.IH H1317
513	513	ssavage on LAPJG3WLY3PROD with BILLS 18
514	514	•HR 1317 IH
515	515	intern or resident-in-training (as described 1
516	516	in subsection (b)(6)); 2
517	517	‘‘(iii) would otherwise be described in 3
518	518	subparagraph (A) if furnished by a cer-4
519	519	tified nurse-midwife; and 5
520	520	‘‘(iv) would otherwise be covered if 6
521	521	furnished under the supervision of a physi-7
522	522	cian.’’. 8
523	523	(b) C
524	524	LARIFYINGPERMISSIBILITY OFUSINGCERTAIN 9
525	525	G
526	526	RANTS FORCLINICALTRAINING BYCERTIFIEDNURSE- 10
527	527	M
528	528	IDWIVES.—Section 811(a)(1) of the Public Health Serv-11
529	529	ice Act (42 U.S.C. 296j(a)(1)) is amended by inserting 12
530	530	‘‘, including clinical training,’’ after ‘‘projects’’. 13
531	531	SEC. 302. IMPROVING MEDICARE PATIENT ACCESS TO 14
532	532	HOME HEALTH SERVICES PROVIDED BY CER-15
533	533	TIFIED NURSE-MIDWIVES. 16
534	534	(a) I
535	535	NGENERAL.—Section 1835(a) of the Social Se-17
536	536	curity Act (42 U.S.C. 1395n(a)) is amended— 18
537	537	(1) in paragraph (2)— 19
538	538	(A) in the matter preceding subparagraph 20
539	539	(A), by inserting ‘‘or a certified nurse-midwife 21
540	540	(as defined in section 1861(gg)),’’ after ‘‘or a 22
541	541	physician assistant (as defined in section 23
542	542	1861(aa)(5)) who is working in accordance with 24
543	543	State law,’’; and 25
544	544	VerDate Sep 11 2014 00:07 Apr 09, 2025 Jkt 059200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\H1317.IH H1317
545	545	ssavage on LAPJG3WLY3PROD with BILLS 19
546	546	•HR 1317 IH
547	547	(B) in subparagraph (A)— 1
548	548	(i) in each of clauses (ii) and (iii), by 2
549	549	striking ‘‘or a physician assistant (as the 3
550	550	case may be)’’ and inserting ‘‘a physician 4
551	551	assistant, or a certified nurse-midwife (as 5
552	552	the case may be)’’; and 6
553	553	(ii) in clause (iv), by— 7
554	554	(I) inserting ‘‘or by a certified 8
555	555	nurse-midwife (as defined in section 9
556	556	1861(gg))’’ after ‘‘(but in no case 10
557	557	later than the date that is 6 months 11
558	558	after the date of the enactment of the 12
559	559	CARES Act)’’; and 13
560	560	(II) by striking ‘‘(as defined in 14
561	561	section 1861(gg))’’; and 15
562	562	(2) in the matter following paragraph (2), by 16
563	563	striking ‘‘or physician assistant (as the case may 17
564	564	be)’’ and inserting ‘‘physician assistant, or certified 18
565	565	nurse-midwife (as the case may be)’’ each place it 19
566	566	appears. 20
567	567	(b) C
568	568	ONFORMINGAMENDMENTS.—Section 1895 of 21
569	569	the Social Security Act (42 U.S.C. 1395(fff)) is amend-22
570	570	ed— 23
571	571	(1) in subsection (c)(1), by inserting ‘‘the cer-24
572	572	tified nurse-midwife (as defined in section 25
573	573	VerDate Sep 11 2014 00:07 Apr 09, 2025 Jkt 059200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\H1317.IH H1317
574	574	ssavage on LAPJG3WLY3PROD with BILLS 20
575	575	•HR 1317 IH
576	576	1861(gg)),’’ after ‘‘clinical nurse specialist (as those 1
577	577	terms are defined in section 1861(aa)(5)),’’; and 2
578	578	(2) in subsection (e)(1)(A), by striking ‘‘a phy-3
579	579	sician a nurse practitioner or clinical nurse spe-4
580	580	cialist,’’ and inserting ‘‘a physician, a nurse practi-5
581	581	tioner, a clinical nurse specialist, a certified nurse- 6
582	582	midwife,’’. 7
583	583	SEC. 303. IMPROVING ACCESS TO DMEPOS FOR MEDICARE 8
584	584	BENEFICIARIES. 9
585	585	Section 1834(a) of the Social Security Act (42 U.S.C. 10
586	586	1395m(a)) is amended— 11
587	587	(1) in paragraph (1)(E)(ii) by striking ‘‘or a 12
588	588	clinical nurse specialist (as those terms are defined 13
589	589	in section 1861(aa)(5))’’ and inserting ‘‘, a clinical 14
590	590	nurse specialist (as those terms are defined in sec-15
591	591	tion 1861(aa)(5)), or a certified nurse-midwife (as 16
592	592	defined in section 1861(gg))’’; and 17
593	593	(2) in paragraph (11)(B)(ii)— 18
594	594	(A) by striking ‘‘or a clinical nurse spe-19
595	595	cialist (as those terms are defined in section 20
596	596	1861(aa)(5))’’ and inserting ‘‘a clinical nurse 21
597	597	specialist (as those terms are defined in section 22
598	598	1861(aa)(5)), or a certified nurse-midwife (as 23
599	599	defined in section 1861(gg))’’; and 24
600	600	VerDate Sep 11 2014 00:07 Apr 09, 2025 Jkt 059200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\H1317.IH H1317
601	601	ssavage on LAPJG3WLY3PROD with BILLS 21
602	602	•HR 1317 IH
603	603	(B) by striking ‘‘or specialist’’ and insert-1
604	604	ing ‘‘specialist, or nurse-midwife’’. 2
605	605	SEC. 304. TECHNICAL CHANGES TO QUALIFICATIONS AND 3
606	606	CONDITIONS WITH RESPECT TO THE SERV-4
607	607	ICES OF CERTIFIED NURSE-MIDWIVES. 5
608	608	Section 1861(gg)(2) of the Social Security Act (42 6
609	609	U.S.C. 1395x(gg)(2)) is amended by striking ‘‘, or has 7
610	610	been certified by an organization recognized by the Sec-8
611	611	retary’’ and inserting ‘‘and has been certified by the Amer-9
612	612	ican Midwifery Certification Board (or a successor organi-10
613	613	zation)’’. 11
614	614	TITLE IV—IMPROVING FEDERAL 12
615	615	HEALTH PROGRAMS FOR ALL 13
616	616	ADVANCED PRACTICE REG-14
617	617	ISTERED NURSES 15
618	618	SEC. 401. REVISING THE LOCAL COVERAGE DETERMINA-16
619	619	TION PROCESS UNDER THE MEDICARE PRO-17
620	620	GRAM. 18
621	621	(a) I
622	622	NGENERAL.—Section 1862(l)(5) of the Social 19
623	623	Security Act (42 U.S.C. 1395y(l)(5)) is amended— 20
624	624	(1) in subparagraph (D), by adding at the end 21
625	625	the following new clauses: 22
626	626	‘‘(vi) Identification of any medical or 23
627	627	scientific experts whose advice was ob-24
628	628	tained by such contractor during the devel-25
629	629	VerDate Sep 11 2014 00:07 Apr 09, 2025 Jkt 059200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\H1317.IH H1317
630	630	ssavage on LAPJG3WLY3PROD with BILLS 22
631	631	•HR 1317 IH
632	632	opment of such determination, whether or 1
633	633	not such contractor relied on such advice 2
634	634	in developing such determination. 3
635	635	‘‘(vii) A hyperlink to any written com-4
636	636	munication between such contractor and 5
637	637	another entity that such contractor relied 6
638	638	on when developing such determination. 7
639	639	‘‘(viii) A hyperlink to any rule, guide-8
640	640	line, protocol, or other criterion that such 9
641	641	contractor relied on when developing such 10
642	642	determination.’’; and 11
643	643	(2) by adding at the end the following new sub-12
644	644	paragraphs: 13
645	645	‘‘(E) P
646	646	ROHIBITION ON IMPOSITION OF 14
647	647	PRACTITIONER QUALIFICATIONS .—The Sec-15
648	648	retary shall prohibit a Medicare administrative 16
649	649	contractor that develops a local coverage deter-17
650	650	mination from imposing such determination on 18
651	651	any coverage limitation with respect to the 19
652	652	qualifications of a physician (as defined in sec-20
653	653	tion 1861(r)) or a practitioner described in sec-21
654	654	tion 1842(b)(18)(C) who may furnish the item 22
655	655	or service that is the subject of such determina-23
656	656	tion. 24
657	657	VerDate Sep 11 2014 00:07 Apr 09, 2025 Jkt 059200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\H1317.IH H1317
658	658	ssavage on LAPJG3WLY3PROD with BILLS 23
659	659	•HR 1317 IH
660	660	‘‘(F) CIVIL MONETARY PENALTY .—A 1
661	661	Medicare administrative contractor that devel-2
662	662	ops a local coverage determination that fails to 3
663	663	make information described in subparagraph 4
664	664	(D) available as required by the Secretary 5
665	665	under such subparagraph or comply with the 6
666	666	prohibition under subparagraph (E) is subject 7
667	667	to a civil monetary penalty of not more than 8
668	668	$10,000 for each such failure. The provisions of 9
669	669	section 1128A (other than subsections (a) and 10
670	670	(b)) shall apply to a civil money penalty under 11
671	671	the previous sentence in the same manner as 12
672	672	such provisions apply to a penalty or proceeding 13
673	673	under section 1128A(a).’’. 14
674	674	(b) T
675	675	IMING OFREVIEW.—Section 1869(f)(2) of the 15
676	676	Social Security Act (42 U.S.C. 1395ff(f)(2)) is amended 16
677	677	by adding at the end the following new subparagraph: 17
678	678	‘‘(D) T
679	679	IMING OF REVIEW.—An aggrieved 18
680	680	party may file a complaint described in sub-19
681	681	paragraph (A) with respect to a local coverage 20
682	682	determination on or after the date that such de-21
683	683	termination is posted, in accordance with sec-22
684	684	tion 1862(l)(5)(D), on the Internet website of 23
685	685	the Medicare administrative contractor making 24
686	686	VerDate Sep 11 2014 00:07 Apr 09, 2025 Jkt 059200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\H1317.IH H1317
687	687	ssavage on LAPJG3WLY3PROD with BILLS 24
688	688	•HR 1317 IH
689	689	such determination, whether or not such deter-1
690	690	mination has taken effect.’’. 2
691	691	(c) E
692	692	FFECTIVEDATE.—The amendments made by 3
693	693	this section shall apply to local coverage determinations 4
694	694	made available on the internet website of a Medicare ad-5
695	695	ministrative contractor and on the Medicare internet 6
696	696	website on or after the date of the enactment of this Act. 7
697	697	SEC. 402. LOCUM TENENS. 8
698	698	Section 1842(b)(6) of the Social Security Act (42 9
699	699	U.S.C. 1395u(b)(6)) is amended, in the first sentence— 10
700	700	(1) by striking ‘‘and (J)’’ and inserting ‘‘(J)’’; 11
701	701	and 12
702	702	(2) by inserting before the period at the end the 13
703	703	following: ‘‘, and (K) in the case of services fur-14
704	704	nished by a certified registered nurse anesthetist (as 15
705	705	defined in section 1861(bb)(2)), nurse practitioner, 16
706	706	or clinical nurse specialist (as defined in section 17
707	707	1861(aa)(5)), or a certified nurse midwife (as de-18
708	708	fined in section 1861(gg)(2)), subparagraph (D) of 19
709	709	this sentence shall apply to such services and such 20
710	710	anesthetist, practitioner, specialist, or nurse-midwife 21
711	711	in the same manner as such subparagraph applies to 22
712	712	physicians’ services furnished by physicians’’. 23
713	713	VerDate Sep 11 2014 00:07 Apr 09, 2025 Jkt 059200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\H1317.IH H1317
714	714	ssavage on LAPJG3WLY3PROD with BILLS 25
715	715	•HR 1317 IH
716	716	TITLE V—EFFECTIVE DATE 1
717	717	SEC. 501. EFFECTIVE DATE. 2
718	718	The provisions of, including the amendments made 3
719	719	by, this Act (other than sections 103 and 401) shall apply 4
720	720	with respect to items and services furnished on or after 5
721	721	the date that is 90 days after the date of the enactment 6
722	722	of this Act. Notwithstanding any other provision of law, 7
723	723	the Secretary of Health and Human Services shall imple-8
724	724	ment such provisions, including such amendments, 9
725	725	through interim final rule or subregulatory guidance if the 10
726	726	Secretary determines such implementation to be necessary 11
727	727	for purposes of complying with the preceding sentence or 12
728	728	with any other effective date provided in this Act. 13
729	729	Æ
730	730	VerDate Sep 11 2014 00:07 Apr 09, 2025 Jkt 059200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6301 E:\BILLS\H1317.IH H1317
731	731	ssavage on LAPJG3WLY3PROD with BILLS