I
119THCONGRESS
1
STSESSION H. R. 1317
To amend titles XVIII and XIX of the Social Security Act to increase
access to services provided by advanced practice registered nurses under
the Medicare and Medicaid programs, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY13, 2025
Mr. J
OYCEof Ohio (for himself, Ms. BONAMICI, Mrs. KIGGANSof Virginia,
Ms. U
NDERWOOD, and Mr. ROGERSof Alabama) introduced the following
bill; which was referred to the Committee on Energy and Commerce, and
in addition to the Committee on Ways and Means, for a period to be sub-
sequently determined by the Speaker, in each case for consideration of
such provisions as fall within the jurisdiction of the committee concerned
A BILL
To amend titles XVIII and XIX of the Social Security Act
to increase access to services provided by advanced prac-
tice registered nurses under the Medicare and Medicaid
programs, and for other purposes.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 3
(a) S
HORTTITLE.—This Act may be cited as the 4
‘‘Improving Care and Access to Nurses Act’’ or the ‘‘I 5
CAN Act’’. 6
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(b) TABLE OFCONTENTS.—The table of contents of 1
this Act is as follows: 2
Sec. 1. Short title; table of contents.
TITLE I—REMOVAL OF BARRIERS TO PRACTICE ON NURSE
PRACTITIONERS
Sec. 101. Expanding access to cardiac rehabilitation programs and pulmonary
rehabilitation programs under Medicare program.
Sec. 102. Permitting nurse practitioners and physician assistants to satisfy
Medicare documentation requirement for coverage of certain
shoes for individuals with diabetes.
Sec. 103. Improvements to the assignment of beneficiaries under the Medicare
shared savings program.
Sec. 104. Expanding the availability of medical nutrition therapy service Medi-
care program.
Sec. 105. Preserving access to home infusion therapy.
Sec. 106. Increasing access to hospice care services.
Sec. 107. Streamlining care delivery in skilled nursing facilities and nursing fa-
cilities; authorizing Medicare and Medicaid inpatient hospital
patients to be under the care of a nurse practitioner.
Sec. 108. Improving access to Medicaid clinic services.
TITLE II—REMOVAL OF BARRIERS TO PRACTICE ON CERTIFIED
REGISTERED NURSE ANESTHETISTS
Sec. 201. Clarifying that certified registered nurse anesthetists can be reim-
bursed by Medicare for evaluation and management services.
Sec. 202. Revision of conditions of payment relating to services ordered and re-
ferred by certified registered nurse anesthetists.
Sec. 203. Special payment rule for teaching student registered nurse anes-
thetists.
Sec. 204. Removing unnecessary and costly supervision of certified registered
nurse anesthetists.
Sec. 205. CRNA services as a Medicaid-required benefit.
TITLE III—REMOVAL OF BARRIERS TO PRACTICE ON CERTIFIED
NURSE-MIDWIVES
Sec. 301. Improving access to training in maternity care.
Sec. 302. Improving Medicare patient access to home health services provided
by certified nurse-midwives.
Sec. 303. Improving access to DMEPOS for Medicare beneficiaries.
Sec. 304. Technical changes to qualifications and conditions with respect to the
services of certified nurse-midwives.
TITLE IV—IMPROVING FEDERAL HEALTH PROGRAMS FOR ALL
ADVANCED PRACTICE REGISTERED NURSES
Sec. 401. Revising the local coverage determination process under the Medicare
program.
Sec. 402. Locum tenens.
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TITLE V—EFFECTIVE DATE
Sec. 501. Effective date.
TITLE I—REMOVAL OF BAR-1
RIERS TO PRACTICE ON 2
NURSE PRACTITIONERS 3
SEC. 101. EXPANDING ACCESS TO CARDIAC REHABILITA-4
TION PROGRAMS AND PULMONARY REHA-5
BILITATION PROGRAMS UNDER MEDICARE 6
PROGRAM. 7
(a) C
ARDIACREHABILITATIONPROGRAMS.—Section 8
1861(eee) of the Social Security Act (42 U.S.C. 9
1395x(eee)) is amended— 10
(1) in paragraph (2)— 11
(A) in subparagraph (A)(i), by striking ‘‘a 12
physician’s office’’ and inserting ‘‘the office set-13
ting’’; and 14
(B) in subparagraph (C), by inserting after 15
‘‘physician’’ the following: ‘‘(as defined in sub-16
section (r)(1)) or a physician assistant, nurse 17
practitioner, or clinical nurse specialist (as 18
those terms are defined in subsection (aa)(5))’’; 19
(2) in paragraph (3)(A), by striking ‘‘physician- 20
prescribed exercise’’ and inserting ‘‘exercise pre-21
scribed by a physician (as defined in subsection 22
(r)(1)) or a physician assistant, nurse practitioner, 23
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or clinical nurse specialist (as those terms are de-1
fined in subsection (aa)(5))’’; and 2
(3) in paragraph (5), by inserting after ‘‘physi-3
cian’’ the following: ‘‘(as defined in subsection 4
(r)(1)) or a physician assistant, nurse practitioner, 5
or clinical nurse specialist (as those terms are de-6
fined in subsection (aa)(5))’’. 7
(b) P
ULMONARYREHABILITATIONPROGRAMS.—Sec-8
tion 1861(fff) of the Social Security Act (42 U.S.C. 9
1395x(fff)) is amended— 10
(1) in paragraph (2)(A), by striking ‘‘physician- 11
prescribed exercise’’ and inserting ‘‘exercise pre-12
scribed by a physician (as defined in subsection 13
(r)(1)) or a physician assistant, nurse practitioner, 14
or clinical nurse specialist (as those terms are de-15
fined in subsection (aa)(5))’’; and 16
(2) in paragraph (3), by inserting after ‘‘physi-17
cian’’ the following: ‘‘(as defined in subsection 18
(r)(1)) or a physician assistant, nurse practitioner, 19
or clinical nurse specialist (as those terms are de-20
fined in subsection (aa)(5))’’. 21
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SEC. 102. PERMITTING NURSE PRACTITIONERS AND PHYSI-1
CIAN ASSISTANTS TO SATISFY MEDICARE 2
DOCUMENTATION REQUIREMENT FOR COV-3
ERAGE OF CERTAIN SHOES FOR INDIVIDUALS 4
WITH DIABETES. 5
Section 1861(s)(12) of the Social Security Act (42 6
U.S.C. 1395x(s)(12)) is amended— 7
(1) in subparagraph (A), by inserting ‘‘, nurse 8
practitioner, or physician assistant’’ after ‘‘physi-9
cian’’; and 10
(2) in subparagraph (C), by inserting ‘‘, nurse 11
practitioner, or physician assistant’’ after each oc-12
currence of ‘‘physician’’. 13
SEC. 103. IMPROVEMENTS TO THE ASSIGNMENT OF BENE-14
FICIARIES UNDER THE MEDICARE SHARED 15
SAVINGS PROGRAM. 16
Section 1899(c)(1) of the Social Security Act (42 17
U.S.C. 1395jjj(c)(1)) is amended— 18
(1) in subparagraph (A), by striking ‘‘and’’ at 19
the end; 20
(2) in subparagraph (B), by striking the period 21
at the end and inserting ‘‘; and’’; and 22
(3) by adding at the end the following new sub-23
paragraph: 24
‘‘(C) in the case of performance years be-25
ginning on or after January 1, 2026, primary 26
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care services provided under this title by an 1
ACO professional described in subsection 2
(h)(1)(B).’’. 3
SEC. 104. EXPANDING THE AVAILABILITY OF MEDICAL NU-4
TRITION THERAPY SERVICE MEDICARE PRO-5
GRAM. 6
Section 1861(vv)(1) of the Social Security Act (42 7
U.S.C. 1395x(vv)(1)) is amended by inserting ‘‘ or a nurse 8
practitioner, a clinical nurse specialist, or a physician as-9
sistant (as such terms are defined in subsection (aa)(5))’’ 10
before the period at the end. 11
SEC. 105. PRESERVING ACCESS TO HOME INFUSION THER-12
APY. 13
(a) A
LLOWINGAPPLICABLEPROVIDERSTOESTAB-14
LISHHOMEINFUSIONTHERAPY PLANS.—Section 15
1861(iii)(1)(B) of the Social Security Act (42 U.S.C. 16
1395x(iii)(1)(B)) is amended— 17
(1) by striking ‘‘a physician (as defined in sub-18
section (r)(1))’’ and inserting ‘‘an applicable pro-19
vider (as defined in paragraph (3)(A))’’; and 20
(2) by striking ‘‘a physician (as so defined)’’ 21
and inserting ‘‘an applicable provider (as so de-22
fined)’’. 23
(b) C
ONFORMINGAMENDMENT.—Section 1834(u)(6) 24
of the Social Security Act (42 U.S.C. 1395m(u)(6)) is 25
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amended by striking ‘‘physician’’ and inserting ‘‘applicable 1
provider (as defined in section 1861(iii)(3)(A))’’. 2
SEC. 106. INCREASING ACCESS TO HOSPICE CARE SERV-3
ICES. 4
(a) I
NGENERAL.—Section 1814(a)(7)(A) of the So-5
cial Security Act (42 U.S.C. 1395f(a)(7)(A)) is amend-6
ed— 7
(1) in clause (i)— 8
(A) in subclause (I), by striking ‘‘a nurse 9
practitioner or’’; 10
(B) in subclause (II), by inserting ‘‘or 11
nurse practitioner’’ after ‘‘physician’’; and 12
(C) in the flush matter following subclause 13
(II), by inserting ‘‘, nurse practitioner’s,’’ after 14
‘‘physician’s’’; and 15
(2) in clause (ii), by striking ‘‘or physician’’ and 16
inserting ‘‘, physician, or nurse practitioner’’. 17
(b) H
OSPICE CARE DEFINITION.—Section 18
1861(dd)(1)(C) of the Social Security Act (42 U.S.C. 19
1395x(dd)(1)(C)) is amended by inserting ‘‘or nurse prac-20
titioner’’ after ‘‘physician’’. 21
(c) N
URSEPRACTITIONERBILLING.—Not later than 22
90 days after the date of the enactment of this Act, the 23
Secretary of Health and Human Services shall revise sec-24
tion 418.304 of title 42, Code of Federal Regulations, to 25
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allow nurse practitioners to bill for services not described 1
in paragraph (a) of such section in the same manner as 2
physicians may bill for such services in accordance with 3
paragraph (b) of such section. Such revision shall provide 4
that such services furnished by a nurse practitioner shall 5
be payable at the percent of the physician fee schedule 6
specified in section 1833(a)(1)(O) of the Social Security 7
Act (42 U.S.C. 1395l(a)(1)(O)). 8
SEC. 107. STREAMLINING CARE DELIVERY IN SKILLED 9
NURSING FACILITIES AND NURSING FACILI-10
TIES; AUTHORIZING MEDICARE AND MED-11
ICAID INPATIENT HOSPITAL PATIENTS TO BE 12
UNDER THE CARE OF A NURSE PRACTI-13
TIONER. 14
(a) M
EDICARE.— 15
(1) C
ERTIFICATION OF POST -HOSPITAL EX-16
TENDED CARE SERVICES .—Section 1814(a)(2) of the 17
Social Security Act (42 U.S.C. 1395f(a)(2)) is 18
amended, in the matter preceding subparagraph (A), 19
by striking ‘‘, or a nurse practitioner,’’ and inserting 20
‘‘or a nurse practitioner (in accordance with State 21
law), or’’. 22
(2) C
ERTIFICATION AUTHORITY FOR NURSE 23
PRACTITIONERS.—Section 1814(a)(3) of the Social 24
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Security Act (42 U.S.C. 1395f(a)(3)) is amended by 1
inserting ‘‘or nurse practitioner’’ after ‘‘physician’’. 2
(3) S
UPERVISION REQUIREMENT IN SKILLED 3
NURSING FACILITY SERVICES AND RESIDENT ’S 4
RIGHTS.—Section 1819 of the Social Security Act 5
(42 U.S.C. 1395i–3(b)(6)) is amended— 6
(A) in subsection (b)— 7
(i) in paragraph (2)(B), by inserting 8
‘‘or nurse practitioner’’ after ‘‘attending 9
physician’’; and 10
(ii) in paragraph (6)— 11
(I) in the heading, by striking 12
‘‘P
HYSICIAN SUPERVISION ’’ and in-13
serting ‘‘S
UPERVISION’’; and 14
(II) in subparagraph (A), by in-15
serting ‘‘or a nurse practitioner, in ac-16
cordance with State law’’ after ‘‘physi-17
cian’’; and 18
(B) in subsection (c)— 19
(i) in subparagraph (1)(A)(i), by in-20
serting ‘‘or nurse practitioner’’ after ‘‘at-21
tending physician’’; 22
(ii) in the flush matter at the end of 23
subparagraph (2)(A), by inserting ‘‘or 24
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nurse practitioner’’ after ‘‘physician’’ in 1
each occurrence; and 2
(iii) in subparagraph (3)(A), by in-3
serting ‘‘or nurse practitioner’’ after ‘‘phy-4
sician’’. 5
(4) A
DMINISTRATION OF PART B .—Section 6
1842(b)(2)(C) of the Social Security Act (42 U.S.C. 7
1395u(b)(2)(C)) is amended, in the second sen-8
tence— 9
(A) by inserting ‘‘or a nurse practitioner’’ 10
after ‘‘a physician’’; and 11
(B) by striking ‘‘or a nurse practitioner 12
working in collaboration with that physician, or 13
both’’. 14
(5) P
ROVISION OF MEDICAL AND OTHER 15
HEALTH SERVICES .—Section 1861(s)(2)(K)(ii) of 16
the Social Security Act (42 U.S.C. 17
1395x(s)(2)(K)(ii)) is amended by striking ‘‘or clin-18
ical nurse specialist (as defined in subsection 19
(aa)(5)) working in collaboration (as defined in sub-20
section (aa)(6)) with a physician (as defined in sub-21
section (r)(1))’’ and inserting ‘‘(as defined in sub-22
section (aa)(5)(A)), or by a clinical nurse specialist 23
(as defined in subsection (aa)(5)(B)) working in col-24
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laboration with a physician (as defined in subsection 1
(r)(1)),’’. 2
(6) P
RIVILEGES FOR NURSE PRACTITIONERS .— 3
Section 1861 of the Social Security Act (42 U.S.C. 4
1395x) is amended— 5
(A) in subsection (e)(4), by inserting ‘‘(or 6
nurse practitioner, in accordance with State 7
law)’’ after ‘‘physician’’; 8
(B) in subsection (f)(1), by inserting ‘‘or 9
nurse practitioner’’ after ‘‘physician’’; and 10
(C) in each of subparagraphs (B) and (F) 11
of subsection (ee)(2), by inserting ‘‘or nurse 12
practitioner’’ after ‘‘physician’’. 13
(b) M
EDICAID.— 14
(1) C
ERTIFICATION AUTHORITY FOR NURSE 15
PRACTITIONERS.—Section 1902(a)(44) of the Social 16
Security Act (42 U.S.C. 1396a(a)(44)) is amended 17
to read as follows: 18
‘‘(44) in each case for which payment for inpa-19
tient hospital services, skilled nursing facility serv-20
ices, services in an intermediate care facility de-21
scribed in section 1905(d), or inpatient mental hos-22
pital services is made under the State plan— 23
‘‘(A) a physician or nurse practitioner (or, 24
in the case of skilled nursing facility services or 25
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intermediate care facility services, a physician 1
or nurse practitioner, or a clinical nurse spe-2
cialist who is not an employee of the facility but 3
is working in collaboration with a physician) 4
certifies at the time of admission, or, if later, 5
the time the individual applies for medical as-6
sistance under the State plan (and a physician 7
or nurse practitioner, or a physician assistant 8
under the supervision of a physician, or, in the 9
case of skilled nursing facility services or inter-10
mediate care facility services, a physician or 11
nurse practitioner, or a clinical nurse specialist 12
who is not an employee of the facility but is 13
working in collaboration with a physician, recer-14
tifies, where such services are furnished over a 15
period of time, in such cases, at least as often 16
as required under section 1903(g)(6) (or, in the 17
case of services that are services provided in an 18
intermediate care facility, every year), and ac-19
companied by such supporting material, appro-20
priate to the case involved, as may be provided 21
in regulations of the Secretary), that such serv-22
ices are or were required to be given on an in-23
patient basis because the individual needs or 24
needed such services, and 25
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‘‘(B) such services were furnished under a 1
plan established and periodically reviewed and 2
evaluated by a physician or nurse practitioner, 3
or, in the case of skilled nursing facility services 4
or intermediate care facility services, by a phy-5
sician or nurse practitioner, or a clinical nurse 6
specialist who is not an employee of the facility 7
but is working in collaboration with a physi-8
cian;’’. 9
(2) N
URSING FACILITY SERVICES SUPERVISION 10
AND CLINICAL RECORDS .—Section 1919(b)(6)(A) of 11
the Social Security Act (42 U.S.C. 1396r(b)(6)(A)) 12
is amended to read as follows: 13
‘‘(A) require that the health care of every 14
resident be provided under the supervision of a 15
physician or nurse practitioner (or, at the op-16
tion of a State, under the supervision of a clin-17
ical nurse specialist or physician assistant who 18
is not an employee of the facility but who is 19
working in collaboration with a physician);’’. 20
SEC. 108. IMPROVING ACCESS TO MEDICAID CLINIC SERV-21
ICES. 22
Section 1905(a)(9) of the Social Security Act (42 23
U.S.C. 1396d(a)(9)) is amended by adding ‘‘or nurse 24
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practitioner’’ after ‘‘physician’’ in both places that it ap-1
pears. 2
TITLE II—REMOVAL OF BAR-3
RIERS TO PRACTICE ON CER-4
TIFIED REGISTERED NURSE 5
ANESTHETISTS 6
SEC. 201. CLARIFYING THAT CERTIFIED REGISTERED 7
NURSE ANESTHETISTS CAN BE REIMBURSED 8
BY MEDICARE FOR EVALUATION AND MAN-9
AGEMENT SERVICES. 10
Section 1861(bb)(1) of the Social Security Act (42 11
U.S.C. 1395x(bb)(1)) is amended by inserting ‘‘, including 12
pre-anesthesia evaluation and management services,’’ 13
after ‘‘and related care’’. 14
SEC. 202. REVISION OF CONDITIONS OF PAYMENT RELAT-15
ING TO SERVICES ORDERED AND REFERRED 16
BY CERTIFIED REGISTERED NURSE ANES-17
THETISTS. 18
Not later than 3 months after the date of enactment 19
of this Act, the Secretary of Health and Human Services 20
shall revise section 410.69 of title 42, Code of Federal 21
Regulations, to clarify that, for purposes of payment 22
under part B of title XVIII of the Social Security Act— 23
(1) certified registered nurse anesthetists are 24
authorized to order, certify, and refer services to the 25
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extent allowed under the law of the State in which 1
the services are furnished; and 2
(2) payment shall be made under such part for 3
such services so ordered, certified, or referred by 4
certified registered nurse anesthetists. 5
SEC. 203. SPECIAL PAYMENT RULE FOR TEACHING STU-6
DENT REGISTERED NURSE ANESTHETISTS. 7
Section 1848(a)(6) of the Social Security Act (42 8
U.S.C. 1395w–4(a)(6)) is amended, in the matter pre-9
ceding subparagraph (A), by inserting ‘‘or student reg-10
istered nurse anesthetists’’ after ‘‘physician residents’’. 11
SEC. 204. REMOVING UNNECESSARY AND COSTLY SUPER-12
VISION OF CERTIFIED REGISTERED NURSE 13
ANESTHETISTS. 14
Section 1861(bb)(2) of the Social Security Act (42 15
U.S.C. 1395x(bb)(2)) is amended— 16
(1) in the second sentence, by inserting ‘‘, but 17
may not require that certified registered nurse anes-18
thetists provide services under the supervision of a 19
physician’’ after ‘‘certification of nurse anes-20
thetists’’; and 21
(2) in the third sentence, by inserting ‘‘under 22
the supervision of an anesthesiologist’’ after ‘‘an an-23
esthesiologist assistant’’. 24
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SEC. 205. CRNA SERVICES AS A MEDICAID-REQUIRED BEN-1
EFIT. 2
(a) I
NGENERAL.—Section 1905(a)(5) of the Social 3
Security Act (42 U.S.C. 1396d(a)(5)) is amended— 4
(1) by striking ‘‘and (B)’’ and inserting ‘‘(B)’’; 5
and 6
(2) by inserting before the semicolon at the end 7
the following: ‘‘, and (C) services furnished by a cer-8
tified registered nurse anesthetist (as defined in sec-9
tion 1861(bb)(2)), which such certified registered 10
nurse anesthetist is authorized to perform under 11
State law (or the State regulatory mechanism as 12
provided by State law)’’. 13
(b) P
AYMENT.—Section 1902(a) of the Social Secu-14
rity Act (42 U.S.C. 1396d(a)) is amended— 15
(1) in paragraph (86), by striking ‘‘and’’ at the 16
end; 17
(2) in paragraph (87), by striking the period 18
and inserting ‘‘; and’’; and 19
(3) by inserting after paragraph (87) the fol-20
lowing new paragraph: 21
‘‘(88) provide for payment for the services of a 22
certified registered nurse anesthetist (as defined in 23
section 1861(bb)(1)) in amounts no lower than the 24
amounts, using the same methodology, used for pay-25
ment for amounts under section 1833(a)(1)(H).’’. 26
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TITLE III—REMOVAL OF BAR-1
RIERS TO PRACTICE ON CER-2
TIFIED NURSE-MIDWIVES 3
SEC. 301. IMPROVING ACCESS TO TRAINING IN MATERNITY 4
CARE. 5
(a) M
EDICAREPAYMENTS FOR SUPERVISION BY 6
C
ERTIFIEDNURSE-MIDWIVES.—Paragraph (1) of section 7
1861(gg) of the Social Security Act (42 U.S.C. 1395x(gg)) 8
is amended to read as follows: 9
‘‘(1) The term ‘certified nurse-midwife services’ 10
means— 11
‘‘(A) such services furnished by a certified 12
nurse-midwife (as defined in paragraph (2)); 13
and 14
‘‘(B) such services (and such supplies and 15
services furnished as an incident to the nurse- 16
midwife’s service) which— 17
‘‘(i) the certified nurse-midwife is le-18
gally authorized to perform under State 19
law (or the State regulatory mechanism 20
provided by State law) as would otherwise 21
be covered if furnished by a physician; 22
‘‘(ii) are furnished under the super-23
vision of a certified-nurse midwife by an 24
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intern or resident-in-training (as described 1
in subsection (b)(6)); 2
‘‘(iii) would otherwise be described in 3
subparagraph (A) if furnished by a cer-4
tified nurse-midwife; and 5
‘‘(iv) would otherwise be covered if 6
furnished under the supervision of a physi-7
cian.’’. 8
(b) C
LARIFYINGPERMISSIBILITY OFUSINGCERTAIN 9
G
RANTS FORCLINICALTRAINING BYCERTIFIEDNURSE- 10
M
IDWIVES.—Section 811(a)(1) of the Public Health Serv-11
ice Act (42 U.S.C. 296j(a)(1)) is amended by inserting 12
‘‘, including clinical training,’’ after ‘‘projects’’. 13
SEC. 302. IMPROVING MEDICARE PATIENT ACCESS TO 14
HOME HEALTH SERVICES PROVIDED BY CER-15
TIFIED NURSE-MIDWIVES. 16
(a) I
NGENERAL.—Section 1835(a) of the Social Se-17
curity Act (42 U.S.C. 1395n(a)) is amended— 18
(1) in paragraph (2)— 19
(A) in the matter preceding subparagraph 20
(A), by inserting ‘‘or a certified nurse-midwife 21
(as defined in section 1861(gg)),’’ after ‘‘or a 22
physician assistant (as defined in section 23
1861(aa)(5)) who is working in accordance with 24
State law,’’; and 25
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(B) in subparagraph (A)— 1
(i) in each of clauses (ii) and (iii), by 2
striking ‘‘or a physician assistant (as the 3
case may be)’’ and inserting ‘‘a physician 4
assistant, or a certified nurse-midwife (as 5
the case may be)’’; and 6
(ii) in clause (iv), by— 7
(I) inserting ‘‘or by a certified 8
nurse-midwife (as defined in section 9
1861(gg))’’ after ‘‘(but in no case 10
later than the date that is 6 months 11
after the date of the enactment of the 12
CARES Act)’’; and 13
(II) by striking ‘‘(as defined in 14
section 1861(gg))’’; and 15
(2) in the matter following paragraph (2), by 16
striking ‘‘or physician assistant (as the case may 17
be)’’ and inserting ‘‘physician assistant, or certified 18
nurse-midwife (as the case may be)’’ each place it 19
appears. 20
(b) C
ONFORMINGAMENDMENTS.—Section 1895 of 21
the Social Security Act (42 U.S.C. 1395(fff)) is amend-22
ed— 23
(1) in subsection (c)(1), by inserting ‘‘the cer-24
tified nurse-midwife (as defined in section 25
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1861(gg)),’’ after ‘‘clinical nurse specialist (as those 1
terms are defined in section 1861(aa)(5)),’’; and 2
(2) in subsection (e)(1)(A), by striking ‘‘a phy-3
sician a nurse practitioner or clinical nurse spe-4
cialist,’’ and inserting ‘‘a physician, a nurse practi-5
tioner, a clinical nurse specialist, a certified nurse- 6
midwife,’’. 7
SEC. 303. IMPROVING ACCESS TO DMEPOS FOR MEDICARE 8
BENEFICIARIES. 9
Section 1834(a) of the Social Security Act (42 U.S.C. 10
1395m(a)) is amended— 11
(1) in paragraph (1)(E)(ii) by striking ‘‘or a 12
clinical nurse specialist (as those terms are defined 13
in section 1861(aa)(5))’’ and inserting ‘‘, a clinical 14
nurse specialist (as those terms are defined in sec-15
tion 1861(aa)(5)), or a certified nurse-midwife (as 16
defined in section 1861(gg))’’; and 17
(2) in paragraph (11)(B)(ii)— 18
(A) by striking ‘‘or a clinical nurse spe-19
cialist (as those terms are defined in section 20
1861(aa)(5))’’ and inserting ‘‘a clinical nurse 21
specialist (as those terms are defined in section 22
1861(aa)(5)), or a certified nurse-midwife (as 23
defined in section 1861(gg))’’; and 24
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(B) by striking ‘‘or specialist’’ and insert-1
ing ‘‘specialist, or nurse-midwife’’. 2
SEC. 304. TECHNICAL CHANGES TO QUALIFICATIONS AND 3
CONDITIONS WITH RESPECT TO THE SERV-4
ICES OF CERTIFIED NURSE-MIDWIVES. 5
Section 1861(gg)(2) of the Social Security Act (42 6
U.S.C. 1395x(gg)(2)) is amended by striking ‘‘, or has 7
been certified by an organization recognized by the Sec-8
retary’’ and inserting ‘‘and has been certified by the Amer-9
ican Midwifery Certification Board (or a successor organi-10
zation)’’. 11
TITLE IV—IMPROVING FEDERAL 12
HEALTH PROGRAMS FOR ALL 13
ADVANCED PRACTICE REG-14
ISTERED NURSES 15
SEC. 401. REVISING THE LOCAL COVERAGE DETERMINA-16
TION PROCESS UNDER THE MEDICARE PRO-17
GRAM. 18
(a) I
NGENERAL.—Section 1862(l)(5) of the Social 19
Security Act (42 U.S.C. 1395y(l)(5)) is amended— 20
(1) in subparagraph (D), by adding at the end 21
the following new clauses: 22
‘‘(vi) Identification of any medical or 23
scientific experts whose advice was ob-24
tained by such contractor during the devel-25
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opment of such determination, whether or 1
not such contractor relied on such advice 2
in developing such determination. 3
‘‘(vii) A hyperlink to any written com-4
munication between such contractor and 5
another entity that such contractor relied 6
on when developing such determination. 7
‘‘(viii) A hyperlink to any rule, guide-8
line, protocol, or other criterion that such 9
contractor relied on when developing such 10
determination.’’; and 11
(2) by adding at the end the following new sub-12
paragraphs: 13
‘‘(E) P
ROHIBITION ON IMPOSITION OF 14
PRACTITIONER QUALIFICATIONS .—The Sec-15
retary shall prohibit a Medicare administrative 16
contractor that develops a local coverage deter-17
mination from imposing such determination on 18
any coverage limitation with respect to the 19
qualifications of a physician (as defined in sec-20
tion 1861(r)) or a practitioner described in sec-21
tion 1842(b)(18)(C) who may furnish the item 22
or service that is the subject of such determina-23
tion. 24
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‘‘(F) CIVIL MONETARY PENALTY .—A 1
Medicare administrative contractor that devel-2
ops a local coverage determination that fails to 3
make information described in subparagraph 4
(D) available as required by the Secretary 5
under such subparagraph or comply with the 6
prohibition under subparagraph (E) is subject 7
to a civil monetary penalty of not more than 8
$10,000 for each such failure. The provisions of 9
section 1128A (other than subsections (a) and 10
(b)) shall apply to a civil money penalty under 11
the previous sentence in the same manner as 12
such provisions apply to a penalty or proceeding 13
under section 1128A(a).’’. 14
(b) T
IMING OFREVIEW.—Section 1869(f)(2) of the 15
Social Security Act (42 U.S.C. 1395ff(f)(2)) is amended 16
by adding at the end the following new subparagraph: 17
‘‘(D) T
IMING OF REVIEW.—An aggrieved 18
party may file a complaint described in sub-19
paragraph (A) with respect to a local coverage 20
determination on or after the date that such de-21
termination is posted, in accordance with sec-22
tion 1862(l)(5)(D), on the Internet website of 23
the Medicare administrative contractor making 24
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such determination, whether or not such deter-1
mination has taken effect.’’. 2
(c) E
FFECTIVEDATE.—The amendments made by 3
this section shall apply to local coverage determinations 4
made available on the internet website of a Medicare ad-5
ministrative contractor and on the Medicare internet 6
website on or after the date of the enactment of this Act. 7
SEC. 402. LOCUM TENENS. 8
Section 1842(b)(6) of the Social Security Act (42 9
U.S.C. 1395u(b)(6)) is amended, in the first sentence— 10
(1) by striking ‘‘and (J)’’ and inserting ‘‘(J)’’; 11
and 12
(2) by inserting before the period at the end the 13
following: ‘‘, and (K) in the case of services fur-14
nished by a certified registered nurse anesthetist (as 15
defined in section 1861(bb)(2)), nurse practitioner, 16
or clinical nurse specialist (as defined in section 17
1861(aa)(5)), or a certified nurse midwife (as de-18
fined in section 1861(gg)(2)), subparagraph (D) of 19
this sentence shall apply to such services and such 20
anesthetist, practitioner, specialist, or nurse-midwife 21
in the same manner as such subparagraph applies to 22
physicians’ services furnished by physicians’’. 23
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TITLE V—EFFECTIVE DATE 1
SEC. 501. EFFECTIVE DATE. 2
The provisions of, including the amendments made 3
by, this Act (other than sections 103 and 401) shall apply 4
with respect to items and services furnished on or after 5
the date that is 90 days after the date of the enactment 6
of this Act. Notwithstanding any other provision of law, 7
the Secretary of Health and Human Services shall imple-8
ment such provisions, including such amendments, 9
through interim final rule or subregulatory guidance if the 10
Secretary determines such implementation to be necessary 11
for purposes of complying with the preceding sentence or 12
with any other effective date provided in this Act. 13
Æ
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