II 

117TH CONGRESS 

2D SESSION S. 5212 

To amend titles XVIII and XIX of the Social Security Act and the Bipartisan 

Budget Act of 2018 to increase access to services provided by advanced 

practice registered nurses under the Medicare and Medicaid programs, 

and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 8, 2022 

Mr. MERKLEY introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To amend titles XVIII and XIX of the Social Security Act 

and the Bipartisan Budget Act of 2018 to increase access to services provided by advanced practice registered 

nurses under the Medicare and Medicaid programs, and 

for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) IN GENERAL.—This Act may be cited as the ‘‘Im5 proving Care and Access to Nurses Act’’ or the ‘‘I CAN 

6 Act’’. 


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1 (b) TABLE OF CONTENTS.—The table of contents of 

2 this Act is as follows: 

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 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 services under 

the Medicare program. 

Sec. 105. Preserving access to home infusion therapy under the Medicare program. 

Sec. 106. Increasing access to hospice care services under the Medicare program. 

Sec. 107. Streamlining care delivery in skilled nursing facilities and nursing facilities; 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 reimbursed by Medicare for evaluation and management services. 

Sec. 202. Revision of conditions of payment relating to services ordered and referred by certified registered nurse anesthetists. 

Sec. 203. Special payment rule for teaching student registered nurse anesthetists. 

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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1 TITLE I—REMOVAL OF BAR2 RIERS TO PRACTICE ON 

3 NURSE PRACTITIONERS 

4 SEC. 101. EXPANDING ACCESS TO CARDIAC REHABILITA5 TION PROGRAMS AND PULMONARY REHA6 BILITATION PROGRAMS UNDER MEDICARE 

7 PROGRAM. 

8 (a) CARDIAC REHABILITATION PROGRAMS.—Section 

9 1861(eee) of the Social Security Act (42 U.S.C. 

10 1395x(eee)) is amended— 

11 (1) in paragraph (2)— 

12 (A) in subparagraph (A)(i), by striking ‘‘a 

13 physician’s office’’ and inserting ‘‘the office of 

14 a physician (as defined in subsection (r)(1)) or 

15 the office of a nurse practitioner, clinical nurse 

16 specialist, or physician assistant (as those terms 

17 are defined in subsection (aa)(5))’’; and 

18 (B) in subparagraph (C), by inserting ‘‘(as 

19 defined in subsection (r)(1)), nurse practitioner, 

20 clinical nurse specialist, or physician assistant 

21 (as those terms are defined in subsection 

22 (aa)(5))’’ after ‘‘physician’’; 

23 (2) in paragraph (3)(A), by striking ‘‘physician24 prescribed exercise’’ and inserting ‘‘exercise pre25 scribed by a physician (as defined in subsection 


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1 (r)(1)), nurse practitioner, clinical nurse specialist, 

2 or physician assistant (as those terms are defined in 

3 subsection (aa)(5))’’; and 

4 (3) in paragraph (5), in the matter preceding 

5 subparagraph (A), by inserting ‘‘(as defined in sub6 section (r)(1)), nurse practitioner, clinical nurse spe7 cialist, or physician assistant (as those terms are de8 fined in subsection (aa)(5)),’’ after ‘‘physician’’. 

9 (b) PULMONARY REHABILITATION PROGRAMS.—Sec10 tion 1861(fff) of the Social Security Act (42 U.S.C. 

11 1395x(fff)) is amended— 

12 (1) in paragraph (2)(A), by striking ‘‘physician13 prescribed exercise’’ and inserting ‘‘exercise pre14 scribed by a physician (as defined in subsection 

15 (r)(1)), nurse practitioner, clinical nurse specialist, 

16 or physician assistant (as those terms are defined in 

17 subsection (aa)(5))’’; and 

18 (2) in paragraph (3), in the matter preceding 

19 subparagraph (A), by inserting after ‘‘physician’’ the 

20 following: ‘‘(as defined in subsection (r)(1)), nurse 

21 practitioner, clinical nurse specialist, or physician as22 sistant (as those terms are defined in subsection 

23 (aa)(5)),’’. 

24 (c) EFFECTIVE DATE.— 


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1 (1) IN GENERAL.—The amendments made by 

2 subsections (a) and (b) shall apply to items and 

3 services furnished on or after the date that is 3 

4 months after the date of enactment of this Act. 

5 (2) EXPEDITING IMPLEMENTATION OF SUPER6 VISION AUTHORITY.—Section 51008(c) of the Bipar7 tisan Budget Act of 2018 (Public Law 115–123; 42 

8 U.S.C. 1395x note) is amended by striking ‘‘Janu9 ary 1, 2024’’ and inserting ‘‘January 1, 2023’’. 

10 SEC. 102. PERMITTING NURSE PRACTITIONERS TO SATISFY 

11 MEDICARE DOCUMENTATION REQUIREMENT 

12 FOR COVERAGE OF CERTAIN SHOES FOR IN13 DIVIDUALS WITH DIABETES. 

14 (a) IN GENERAL.—Section 1861(s)(12) of the Social 

15 Security Act (42 U.S.C. 1395x(s)(12)) is amended— 

16 (1) in subparagraph (A), by inserting ‘‘, nurse 

17 practitioner, or physician assistant’’ after ‘‘physi18 cian’’; and 

19 (2) in subparagraph (C), by inserting ‘‘, nurse 

20 practitioner, or physician assistant’’ after ‘‘physi21 cian’’ each place it appears. 

22 (b) EFFECTIVE DATE.—The amendments made by 

23 this section shall apply to items and services furnished on 

24 or after January 1, 2023. 


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1 SEC. 103. IMPROVEMENTS TO THE ASSIGNMENT OF BENE2 FICIARIES UNDER THE MEDICARE SHARED 

3 SAVINGS PROGRAM. 

4 Section 1899(c)(1) of the Social Security Act (42 

5 U.S.C. 1395jjj(c)(1)) is amended— 

6 (1) in subparagraph (A), by striking ‘‘and’’ at 

7 the end; 

8 (2) in subparagraph (B), by striking the period 

9 at the end and inserting ‘‘; and’’; and 

10 (3) by adding at the end the following new sub11 paragraph: 

12 ‘‘(C) in the case of performance years be13 ginning on or after January 1, 2023, primary 

14 care services provided under this title by an 

15 ACO professional described in subsection 

16 (h)(1)(B).’’. 

17 SEC. 104. EXPANDING THE AVAILABILITY OF MEDICAL NU18 TRITION THERAPY SERVICES UNDER THE 

19 MEDICARE PROGRAM. 

20 Section 1861(vv)(1) of the Social Security Act (42 

21 U.S.C. 1395x(vv)(1)) is amended by inserting ‘‘, a nurse 

22 practitioner, or a clinical nurse specialist (as such terms 

23 are defined in subsection (aa)(5))’’ before the period at 

24 the end. 


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1 SEC. 105. PRESERVING ACCESS TO HOME INFUSION THER2 APY UNDER THE MEDICARE PROGRAM. 

3 (a) ALLOWING APPLICABLE PROVIDERS TO ESTAB4 LISH HOME INFUSION THERAPY PLANS.—Section 

5 1861(iii)(1)(B) of the Social Security Act (42 U.S.C. 

6 1395x(iii)(1)(B)) is amended— 

7 (1) by striking ‘‘a physician (as defined in sub8 section (r)(1))’’ and inserting ‘‘an applicable pro9 vider (as defined in paragraph (3)(A))’’; and 

10 (2) by striking ‘‘a physician (as so defined)’’ 

11 and inserting ‘‘an applicable provider (as so de12 fined)’’. 

13 (b) CONFORMING AMENDMENT.—Section 1834(u)(6) 

14 of the Social Security Act (42 U.S.C. 1395m(u)(6)) is 

15 amended by striking ‘‘physician’’ and inserting ‘‘applicable 

16 provider (as defined in section 1861(iii)(3)(A))’’. 

17 SEC. 106. INCREASING ACCESS TO HOSPICE CARE SERV18 ICES UNDER THE MEDICARE PROGRAM. 

19 (a) IN GENERAL.—Section 1814(a)(7)(A) of the So20 cial Security Act (42 U.S.C. 1395f(a)(7)(A)) is amend21 ed— 

22 (1) in clause (i)(I), by striking ‘‘a nurse practi23 tioner or’’; 

24 (2) in clause (i)(II), by inserting ‘‘or nurse 

25 practitioner’’ after ‘‘physician’’; and 


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1 (3) in clause (ii), by striking ‘‘or physician’’ and 

2 inserting ‘‘, physician, or nurse practitioner’’. 

3 (b) HOSPICE CARE DEFINITION.—Section 

4 1861(dd)(1)(C) of the Social Security Act (42 U.S.C. 

5 1395x(dd)(1)(C)) is amended by inserting ‘‘or nurse prac6 titioner’’ after ‘‘physician’’. 

7 SEC. 107. STREAMLINING CARE DELIVERY IN SKILLED 

8 NURSING FACILITIES AND NURSING FACILI9 TIES; AUTHORIZING MEDICARE AND MED10 ICAID INPATIENT HOSPITAL PATIENTS TO BE 

11 UNDER THE CARE OF A NURSE PRACTI12 TIONER. 

13 (a) MEDICARE.— 

14 (1) CERTIFICATION OF POST-HOSPITAL EX15 TENDED CARE SERVICES.—Section 1814(a)(2) of the 

16 Social Security Act (42 U.S.C. 1395f(a)(2)) is 

17 amended, in the matter preceding subparagraph (A), 

18 by striking ‘‘, or a nurse practitioner,’’ and inserting 

19 ‘‘or a nurse practitioner (in accordance with State 

20 law), or’’. 

21 (2) CERTIFICATION AUTHORITY FOR NURSE

22 PRACTITIONERS.—Section 1814(a)(3) of the Social 

23 Security Act (42 U.S.C. 1395f(a)(3)) is amended by 

24 inserting ‘‘or nurse practitioner’’ after ‘‘physician’’. 


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1 (3) SUPERVISION REQUIREMENT IN SKILLED

2 NURSING FACILITY SERVICES.—Section 

3 1819(b)(6)(A) of the Social Security Act (42 U.S.C. 

4 1395i–3(b)(6)(A)) is amended— 

5 (A) in the heading, by striking ‘‘PHYSI6 CIAN SUPERVISION’’ and inserting ‘‘SUPER7 VISION’’; and 

8 (B) by inserting ‘‘or a nurse practitioner, 

9 in accordance with State law’’ after ‘‘physi10 cian’’. 

11 (4) ADMINISTRATION OF PART B.—Section 

12 1842(b)(2)(C) of the Social Security Act (42 U.S.C. 

13 1395u(b)(2)(C)) is amended, in the second sentence, 

14 by striking ‘‘working in collaboration with that phy15 sician’’. 

16 (5) PROVISION OF MEDICAL AND OTHER

17 HEALTH SERVICES.—Section 1861(s)(2)(K)(ii) of 

18 the Social Security Act (42 U.S.C. 

19 1395x(s)(2)(K)(ii)) is amended by striking ‘‘or clin20 ical nurse specialist (as defined in subsection 

21 (aa)(5)) working in collaboration (as defined in sub22 section (aa)(6)) with a physician (as defined in sub23 section (r)(1))’’ and inserting ‘‘(as defined in sub24 section (aa)(5)(A)), or by a clinical nurse specialist 

25 (as defined in subsection (aa)(5)(B)) working in colVerDate Sep 11 2014 22:52 Dec 12, 2022 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S5212.IS S5212

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1 laboration with a physician (as defined in subsection 

2 (r)(1)),’’. 

3 (6) PRIVILEGES FOR NURSE PRACTITIONERS.— 

4 Section 1861 of the Social Security Act (42 U.S.C. 

5 1395x) is amended— 

6 (A) in subsection (e)(4), by inserting ‘‘(or 

7 nurse practitioner, in accordance with State 

8 law)’’ after ‘‘physician’’; 

9 (B) in subsection (f)(1), by inserting ‘‘or 

10 nurse practitioner’’ after ‘‘physician’’; and 

11 (C) in each of subparagraphs (B) and (F) 

12 of subsection (ee)(2), by inserting ‘‘or nurse 

13 practitioner’’ after ‘‘physician’’. 

14 (b) MEDICAID.— 

15 (1) CERTIFICATION AUTHORITY FOR NURSE

16 PRACTITIONERS.—Section 1902(a)(44) of the Social 

17 Security Act (42 U.S.C. 1396a(a)(44)) is amended 

18 to read as follows: 

19 ‘‘(44) in each case for which payment for inpa20 tient hospital services, skilled nursing facility serv21 ices, services in an intermediate care facility de22 scribed in section 1905(d), or inpatient mental hos23 pital services is made under the State plan— 

24 ‘‘(A) a physician or nurse practitioner (or, 

25 in the case of skilled nursing facility services or 


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1 intermediate care facility services, a physician 

2 or nurse practitioner, or a clinical nurse spe3 cialist who is not an employee of the facility but 

4 is working in collaboration with a physician) 

5 certifies at the time of admission, or, if later, 

6 the time the individual applies for medical as7 sistance under the State plan (and a physician 

8 or nurse practitioner, or a physician assistant 

9 under the supervision of a physician, or, in the 

10 case of skilled nursing facility services or inter11 mediate care facility services, a physician or 

12 nurse practitioner, or a clinical nurse specialist 

13 who is not an employee of the facility but is 

14 working in collaboration with a physician, recer15 tifies, where such services are furnished over a 

16 period of time, in such cases, at least as often 

17 as required under section 1903(g)(6) (or, in the 

18 case of services that are services provided in an 

19 intermediate care facility, every year), and ac20 companied by such supporting material, appro21 priate to the case involved, as may be provided 

22 in regulations of the Secretary), that such serv23 ices are or were required to be given on an in24 patient basis because the individual needs or 

25 needed such services, and 


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1 ‘‘(B) such services were furnished under a 

2 plan established and periodically reviewed and 

3 evaluated by a physician or nurse practitioner, 

4 or, in the case of skilled nursing facility services 

5 or intermediate care facility services, by a phy6 sician or nurse practitioner, or a clinical nurse 

7 specialist who is not an employee of the facility 

8 but is working in collaboration with a physi9 cian;’’. 

10 (2) NURSING FACILITY SERVICES SUPERVISION

11 AND CLINICAL RECORDS.—Section 1919(b)(6)(A) of 

12 the Social Security Act (42 U.S.C. 1396r(b)(6)(A)) 

13 is amended to read as follows: 

14 ‘‘(A) require that the health care of every 

15 resident be provided under the supervision of a 

16 physician or nurse practitioner (or, at the op17 tion of a State, under the supervision of a clin18 ical nurse specialist or physician assistant who 

19 is not an employee of the facility but who is 

20 working in collaboration with a physician);’’. 

21 SEC. 108. IMPROVING ACCESS TO MEDICAID CLINIC SERV22 ICES. 

23 Section 1905(a)(9) of the Social Security Act (42 

24 U.S.C. 1396d(a)(9)) is amended by adding ‘‘or nurse 


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1 practitioner’’ after ‘‘physician’’ in both places that it ap2 pears. 

3 TITLE II—REMOVAL OF BAR4 RIERS TO PRACTICE ON CER5 TIFIED REGISTERED NURSE 

6 ANESTHETISTS 

7 SEC. 201. CLARIFYING THAT CERTIFIED REGISTERED 

8 NURSE ANESTHETISTS CAN BE REIMBURSED 

9 BY MEDICARE FOR EVALUATION AND MAN10 AGEMENT SERVICES. 

11 Section 1861(bb)(1) of the Social Security Act (42 

12 U.S.C. 1395x(bb)(1)) is amended by inserting ‘‘, including 

13 pre-anesthesia evaluation and management services,’’ 

14 after ‘‘and related care’’. 

15 SEC. 202. REVISION OF CONDITIONS OF PAYMENT RELAT16 ING TO SERVICES ORDERED AND REFERRED 

17 BY CERTIFIED REGISTERED NURSE ANES18 THETISTS. 

19 Not later than 3 months after the date of enactment 

20 of this Act, the Secretary of Health and Human Services 

21 shall revise section 410.69 of title 42, Code of Federal 

22 Regulations, to clarify that, for purposes of payment 

23 under part B of title XVIII of the Social Security Act— 

24 (1) certified registered nurse anesthetists are 

25 authorized to order, certify, and refer services to the 


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1 extent allowed under the law of the State in which 

2 the services are furnished; and 

3 (2) payment shall be made under such part for 

4 such services so ordered, certified, or referred by 

5 certified registered nurse anesthetists. 

6 SEC. 203. SPECIAL PAYMENT RULE FOR TEACHING STU7 DENT REGISTERED NURSE ANESTHETISTS. 

8 Section 1848(a)(6) of the Social Security Act (42 

9 U.S.C. 1395w–4(a)(6)) is amended, in the matter pre10 ceding subparagraph (A), by inserting ‘‘or student reg11 istered nurse anesthetists’’ after ‘‘physician residents’’. 

12 SEC. 204. REMOVING UNNECESSARY AND COSTLY SUPER13 VISION OF CERTIFIED REGISTERED NURSE 

14 ANESTHETISTS. 

15 Section 1861(bb)(2) of the Social Security Act (42 

16 U.S.C. 1395x(bb)(2)) is amended— 

17 (1) in the second sentence, by inserting ‘‘, but 

18 may not require that certified registered nurse anes19 thetists provide services under the supervision of a 

20 physician’’ after ‘‘certification of nurse anes21 thetists’’; and 

22 (2) in the third sentence, by inserting ‘‘under 

23 the supervision of an anesthesiologist’’ after ‘‘an an24 esthesiologist assistant’’. 


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1 SEC. 205. CRNA SERVICES AS A MEDICAID-REQUIRED BEN2 EFIT. 

3 (a) IN GENERAL.—Section 1905(a)(5) of the Social 

4 Security Act (42 U.S.C. 1396d(a)(5)) is amended— 

5 (1) by striking ‘‘and (B)’’ and inserting ‘‘(B)’’; 

6 and 

7 (2) by inserting before the semicolon at the end 

8 the following: ‘‘, and (C) services furnished by a cer9 tified registered nurse anesthetist (as defined in sec10 tion 1861(bb)(2)), which such certified registered 

11 nurse anesthetist is authorized to perform under 

12 State law (or the State regulatory mechanism as 

13 provided by State law)’’. 

14 (b) PAYMENT.—Section 1902(a) of the Social Secu15 rity Act (42 U.S.C. 1396d(a)) is amended— 

16 (1) in paragraph (86), by striking ‘‘and’’ at the 

17 end; 

18 (2) in paragraph (87), by striking the period 

19 and inserting ‘‘; and’’; and 

20 (3) by inserting after paragraph (87) the fol21 lowing new paragraph: 

22 ‘‘(88) provide for payment for the services of a 

23 certified registered nurse anesthetist (as defined in 

24 section 1861(bb)(1)) in amounts no lower than the 

25 amounts, using the same methodology, used for pay26 ment for amounts under section 1833(a)(1)(H).’’. 


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1 TITLE III—REMOVAL OF BAR2 RIERS TO PRACTICE ON CER3 TIFIED NURSE-MIDWIVES 

4 SEC. 301. IMPROVING ACCESS TO TRAINING IN MATERNITY 

5 CARE. 

6 (a) MEDICARE PAYMENTS FOR SUPERVISION BY

7 CERTIFIED NURSE-MIDWIVES.—Paragraph (1) of section 

8 1861(gg) of the Social Security Act (42 U.S.C. 1395x(gg)) 

9 is amended to read as follows: 

10 ‘‘(1) The term ‘certified nurse-midwife services’ 

11 means— 

12 ‘‘(A) such services furnished by a certified 

13 nurse-midwife (as defined in paragraph (2)); 

14 and 

15 ‘‘(B) such services (and such supplies and 

16 services furnished as an incident to the nurse17 midwife’s service) which— 

18 ‘‘(i) the certified nurse-midwife is le19 gally authorized to perform under State 

20 law (or the State regulatory mechanism 

21 provided by State law) as would otherwise 

22 be covered if furnished by a physician; 

23 ‘‘(ii) are furnished under the super24 vision of a certified-nurse midwife by an 


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1 intern or resident-in-training (as described 

2 in subsection (b)(6)); 

3 ‘‘(iii) would otherwise be described in 

4 subparagraph (A) if furnished by a cer5 tified nurse-midwife; and 

6 ‘‘(iv) would otherwise be covered if 

7 furnished under the supervision of a physi8 cian.’’. 

9 (b) CLARIFYING PERMISSIBILITY OF USING CERTAIN

10 GRANTS FOR CLINICAL TRAINING BY CERTIFIED NURSE11 MIDWIVES.—Section 811(a)(1) of the Public Health Serv12 ice Act (42 U.S.C. 296j(a)(1)) is amended by inserting 

13 ‘‘, including clinical training,’’ after ‘‘projects’’. 

14 SEC. 302. IMPROVING MEDICARE PATIENT ACCESS TO 

15 HOME HEALTH SERVICES PROVIDED BY CER16 TIFIED NURSE-MIDWIVES. 

17 (a) IN GENERAL.—Section 1835(a) of the Social Se18 curity Act (42 U.S.C. 1395n(a)) is amended— 

19 (1) in paragraph (2)— 

20 (A) by inserting ‘‘or a certified nurse-mid21 wife (as defined in section 1861(gg)),’’ after ‘‘or 

22 a physician assistant (as defined in section 

23 1861(aa)(5)) who is working in accordance with 

24 State law,’’; and 

25 (B) in subparagraph (A)— 


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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) CONFORMING AMENDMENTS.—Section 1895 of 

21 the Social Security Act (42 U.S.C. 1395fff) is amended— 

22 (1) in subsection (c)(1), by inserting ‘‘a cer23 tified nurse-midwife (as defined in section 

24 1861(gg)),’’ after ‘‘clinical nurse specialist (as those 

25 terms are defined in section 1861(aa)(5)),’’; and 


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1 (2) in subsection (e)(1)(A), by striking ‘‘a phy2 sician a nurse practitioner or clinical nurse spe3 cialist,’’ and inserting ‘‘a physician, a nurse practi4 tioner, a clinical nurse specialist, a certified nurse5 midwife,’’. 

6 SEC. 303. IMPROVING ACCESS TO DMEPOS FOR MEDICARE 

7 BENEFICIARIES. 

8 Section 1834(a) of the Social Security Act (42 U.S.C. 

9 1395m(a)) is amended— 

10 (1) in paragraph (1)(E)(ii) by striking ‘‘or a 

11 clinical nurse specialist (as those terms are defined 

12 in section 1861(aa)(5))’’ and inserting ‘‘, a clinical 

13 nurse specialist (as those terms are defined in sec14 tion 1861(aa)(5)), or a certified nurse-midwife (as 

15 defined in section 1861(gg))’’; and 

16 (2) in paragraph (11)(B)(ii)— 

17 (A) by striking ‘‘or a clinical nurse spe18 cialist (as those terms are defined in section 

19 1861(aa)(5))’’ and inserting ‘‘a clinical nurse 

20 specialist (as those terms are defined in section 

21 1861(aa)(5)), or a certified nurse-midwife (as 

22 defined in section 1861(gg))’’; and 

23 (B) by striking ‘‘or specialist’’ and insert24 ing ‘‘specialist, or nurse-midwife’’. 


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1 SEC. 304. TECHNICAL CHANGES TO QUALIFICATIONS AND 

2 CONDITIONS WITH RESPECT TO THE SERV3 ICES OF CERTIFIED NURSE-MIDWIVES. 

4 Section 1861(gg)(2) of the Social Security Act (42 

5 U.S.C. 1395x(gg)(2)) is amended by striking ‘‘, or has 

6 been certified by an organization recognized by the Sec7 retary’’ and inserting ‘‘and has been certified by the Amer8 ican Midwifery Certification Board (or a successor organi9 zation)’’. 

10 TITLE IV—IMPROVING FEDERAL 

11 HEALTH PROGRAMS FOR ALL 

12 ADVANCED PRACTICE REG13 ISTERED NURSES 

14 SEC. 401. REVISING THE LOCAL COVERAGE DETERMINA15 TION PROCESS UNDER THE MEDICARE PRO16 GRAM. 

17 (a) IN GENERAL.—Section 1862(l)(5) of the Social 

18 Security Act (42 U.S.C. 1395y(l)(5)) is amended— 

19 (1) in subparagraph (D), by adding at the end 

20 the following new clauses: 

21 ‘‘(vi) Identification of any medical or 

22 scientific experts whose advice was ob23 tained by such contractor during the devel24 opment of such determination, whether or 

25 not such contractor relied on such advice 

26 in developing such determination. 


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1 ‘‘(vii) A hyperlink to any written com2 munication between such contractor and 

3 another entity that such contractor relied 

4 on when developing such determination. 

5 ‘‘(viii) A hyperlink to any rule, guide6 line, protocol, or other criterion that such 

7 contractor relied on when developing such 

8 determination.’’; and 

9 (2) by adding at the end the following new sub10 paragraphs: 

11 ‘‘(E) PROHIBITION ON IMPOSITION OF

12 PRACTITIONER QUALIFICATIONS.—The Sec13 retary shall prohibit a Medicare administrative 

14 contractor that develops a local coverage deter15 mination from imposing such determination on 

16 any coverage limitation with respect to the 

17 qualifications of a physician (as defined in sec18 tion 1861(r)) or a practitioner described in sec19 tion 1842(b)(18)(C) who may furnish the item 

20 or service that is the subject of such determina21 tion. 

22 ‘‘(F) CIVIL MONETARY PENALTY.—A 

23 Medicare administrative contractor that devel24 ops a local coverage determination that fails to 

25 make information described in subparagraph 


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•S 5212 IS

1 (D) available as required by the Secretary 

2 under such subparagraph or comply with the 

3 prohibition under subparagraph (E) is subject 

4 to a civil monetary penalty of not more than 

5 $10,000 for each such failure. The provisions of 

6 section 1128A (other than subsections (a) and 

7 (b)) shall apply to a civil money penalty under 

8 the previous sentence in the same manner as 

9 such provisions apply to a penalty or proceeding 

10 under section 1128A(a).’’. 

11 (b) TIMING OF REVIEW.—Section 1869(f)(2) of the 

12 Social Security Act (42 U.S.C. 1395ff(f)(2)) is amended 

13 by adding at the end the following new subparagraph: 

14 ‘‘(D) TIMING OF REVIEW.—An aggrieved 

15 party may file a complaint described in sub16 paragraph (A) with respect to a local coverage 

17 determination on or after the date that such de18 termination is posted, in accordance with sec19 tion 1862(l)(5)(D), on the Internet website of 

20 the Medicare administrative contractor making 

21 such determination, whether or not such deter22 mination has taken effect.’’. 

23 (c) EFFECTIVE DATE.—The amendments made by 

24 this section shall apply to local coverage determinations 

25 made available on the Internet website of a Medicare adVerDate Sep 11 2014 22:52 Dec 12, 2022 Jkt 039200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\S5212.IS S5212

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1 ministrative contractor and on the Medicare Internet 

2 website on or after the date of the enactment of this Act. 

3 SEC. 402. LOCUM TENENS. 

4 (a) IN GENERAL.—Section 1842(b)(6) of the Social 

5 Security Act (42 U.S.C. 1395u(b)(6)) is amended— 

6 (1) by striking ‘‘and (J)’’ and inserting ‘‘, (J)’’; 

7 and 

8 (2) by inserting before the period at the end the 

9 following ‘‘, and (K) in the case of services furnished 

10 by a certified registered nurse anesthetist (as de11 fined in section 1861(bb)(2)), nurse practitioner, or 

12 clinical nurse specialist (as defined in section 

13 1861(aa)(5)), or a certified nurse-midwife (as de14 fined in section 1861(gg)(2)), subparagraph (D) of 

15 this sentence shall apply to such services and such 

16 anesthetist, practitioner, specialist, or nurse-midwife 

17 in the same manner as such subparagraph applies to 

18 physicians’ services furnished by physicians’’. 

19 (b) IMPLEMENTATION.—Not later than 90 days after 

20 the date of the enactment of this Act, the Secretary of 

21 Health and Human Services shall update all applicable 

22 regulations and subregulatory guidance necessary to carry 

23 out this section. 

Æ 


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