I 
117TH CONGRESS 
2D SESSION 
H. R. 8812 
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 HOUSE OF REPRESENTATIVES 
SEPTEMBER 13, 2022 
Ms. ROYBAL-ALLARD (for herself, Mr. JOYCE of Ohio, Mr. BLUMENAUER, and 
Mr. SMITH of Nebraska) introduced the following bill; which was referred 
to the Committee on Energy and Commerce, and in addition to the Com-
mittee on Ways and Means, for a period to be subsequently determined 
by the Speaker, in each case for consideration of such provisions as fall 
within the jurisdiction of the committee concerned 
A BILL 
To amend titles XVIII and XIX of the Social Security Act 
and the Bipartisan Budget Act of 2018 to increase ac-
cess to services provided by advanced practice registered 
nurses under the Medicare and Medicaid programs, and 
for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Improving Care and 
Access to Nurses Act’’ or the ‘‘I CAN Act’’. 
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TITLE 
I—REMOVAL 
OF 
BAR-
RIERS 
TO 
PRACTICE 
ON 
NURSE PRACTITIONERS 
SEC. 101. EXPANDING ACCESS TO CARDIAC REHABILITA-
TION PROGRAMS AND PULMONARY REHA-
BILITATION PROGRAMS UNDER MEDICARE 
PROGRAM. 
(a) CARDIAC REHABILITATION PROGRAMS.—Section 
1861(eee) of the Social Security Act (42 U.S.C. 
1395x(eee)) is amended— 
(1) in paragraph (2)— 
(A) in subparagraph (A)(i), by striking ‘‘a 
physician’s office’’ and inserting ‘‘the office of 
a physician (as defined in subsection (r)(1)) or 
the office of a nurse practitioner, clinical nurse 
specialist, or physician assistant (as those terms 
are defined in subsection (aa)(5))’’; and 
(B) in subparagraph (C), by inserting ‘‘(as 
defined in subsection (r)(1)), nurse practitioner, 
clinical nurse specialist, or physician assistant 
(as those terms are defined in subsection 
(aa)(5))’’ after ‘‘physician’’; 
(2) in paragraph (3)(A), by striking ‘‘physician- 
prescribed exercise’’ and inserting ‘‘exercise pre-
scribed by a physician (as defined in subsection 
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(r)(1)), nurse practitioner, clinical nurse specialist, 
or physician assistant (as those terms are defined in 
subsection (aa)(5))’’; and 
(3) in paragraph (5), by inserting ‘‘(as defined 
in subsection (r)(1)), nurse practitioner, clinical 
nurse specialist, or physician assistant (as those 
terms are defined in subsection (aa)(5)),’’ after 
‘‘physician’’. 
(b) PULMONARY REHABILITATION PROGRAMS.—Sec-
tion 1861(fff) of the Social Security Act (42 U.S.C. 
1395x(fff)) is amended— 
(1) in paragraph (2)(A), by striking ‘‘physician- 
prescribed exercise’’ and inserting ‘‘exercise pre-
scribed by a physician (as defined in subsection 
(r)(1)), nurse practitioner, clinical nurse specialist, 
or physician assistant (as those terms are defined in 
subsection (aa)(5))’’; and 
(2) in paragraph (3), by inserting after ‘‘physi-
cian’’ the following: ‘‘(as defined in subsection 
(r)(1)), nurse practitioner, clinical nurse specialist, 
or physician assistant (as those terms are defined in 
subsection (aa)(5)),’’. 
(c) EFFECTIVE DATE.— 
(1) IN GENERAL.—The amendments made by 
subsections (a) and (b) shall apply to items and 
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services furnished on or after the date that is three 
months after the date of enactment of this Act. 
(2) EXPEDITING IMPLEMENTATION OF SUPER-
VISION AUTHORITY.—Section 51008(c) of the Bipar-
tisan Budget Act of 2018 (Public Law 115–123; 42 
U.S.C. 1395x note) is amended by striking ‘‘Janu-
ary 1, 2024’’ and inserting ‘‘January 1, 2023’’. 
SEC. 102. PERMITTING NURSE PRACTITIONERS TO SATISFY 
MEDICARE DOCUMENTATION REQUIREMENT 
FOR COVERAGE OF CERTAIN SHOES FOR IN-
DIVIDUALS WITH DIABETES. 
(a) IN GENERAL.—Section 1861(s)(12) of the Social 
Security Act (42 U.S.C. 1395x(s)(12)) is amended— 
(1) in subparagraph (A), by inserting ‘‘, nurse 
practitioner, or physician assistant’’ after ‘‘physi-
cian’’; and 
(2) in subparagraph (C), by inserting ‘‘, nurse 
practitioner, or physician assistant’’ after each oc-
currence of ‘‘physician’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services furnished on 
or after January 1, 2023. 
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SEC. 103. IMPROVEMENTS TO THE ASSIGNMENT OF BENE-
FICIARIES UNDER THE MEDICARE SHARED 
SAVINGS PROGRAM. 
Section 1899(c)(1) of the Social Security Act (42 
U.S.C. 1395jjj(c)(1)) is amended— 
(1) in subparagraph (A), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (B), by striking the period 
at the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(C) in the case of performance years be-
ginning on or after January 1, 2023, primary 
care services provided under this title by an 
ACO 
professional 
described 
in 
subsection 
(h)(1)(B).’’. 
SEC. 104. EXPANDING THE AVAILABILITY OF MEDICAL NU-
TRITION THERAPY SERVICE MEDICARE PRO-
GRAM. 
Section 1861(vv)(1) of the Social Security Act (42 
U.S.C. 1395x(vv)(1)) is amended by inserting ‘‘, a nurse 
practitioner, or a clinical nurse specialist (as such terms 
are defined in subsection (aa)(5))’’ before the period at 
the end. 
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SEC. 105. PRESERVING ACCESS TO HOME INFUSION THER-
APY. 
(a) ALLOWING APPLICABLE PROVIDERS TO ESTAB-
LISH
HOME
INFUSION
THERAPY
PLANS.—Section 
1861(iii)(1)(B) of the Social Security Act (42 U.S.C. 
1395x(iii)(1)(B)) is amended— 
(1) by striking ‘‘a physician (as defined in sub-
section (r)(1))’’ and inserting ‘‘an applicable pro-
vider (as defined in paragraph (3)(A))’’; and 
(2) by striking ‘‘a physician (as so defined)’’ 
and inserting ‘‘an applicable provider (as so de-
fined)’’. 
(b) CONFORMING AMENDMENT.—Section 1834(u)(6) 
of the Social Security Act (42 U.S.C. 1395m(u)(6)) is 
amended by striking ‘‘physician’’ and inserting ‘‘applicable 
provider (as defined in section 1861(iii)(3)(A))’’. 
SEC. 106. INCREASING ACCESS TO HOSPICE CARE SERV-
ICES. 
(a) IN GENERAL.—Section 1814(a)(7)(A) of the So-
cial Security Act (42 U.S.C. 1395f(a)(7)(A)) is amend-
ed— 
(1) in clause (i)(I), by striking ‘‘a nurse practi-
tioner or’’; 
(2) in clause (i)(II), by inserting ‘‘or nurse 
practitioner’’ after ‘‘physician’’; and 
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(3) in clause (ii), by striking ‘‘or physician’’ and 
inserting ‘‘, physician, or nurse practitioner’’. 
(b) 
HOSPICE
CARE
DEFINITION.—Section 
1861(dd)(1)(C) of the Social Security Act (42 U.S.C. 
1395x(dd)(1)(C)) is amended by adding ‘‘or nurse practi-
tioner’’ after ‘‘physician’’. 
SEC. 107. STREAMLINING CARE DELIVERY IN SKILLED 
NURSING FACILITIES AND NURSING FACILI-
TIES. 
(a) MEDICARE.— 
(1) CERTIFICATION
OF
POST-HOSPITAL
EX-
TENDED CARE SERVICES.—Section 1814(a)(2) of the 
Social Security Act (42 U.S.C. 1395f(a)(2)) is 
amended by striking ‘‘, or a nurse practitioner,’’ and 
inserting ‘‘or a nurse practitioner (in accordance 
with State law), or’’. 
(2) SUPERVISION
REQUIREMENT
IN
SKILLED 
NURSING
FACILITY
SERVICES.—Section 
1819(b)(6)(A) of the Social Security Act (42 U.S.C. 
1395i–3(b)(6)(A)) is amended by inserting ‘‘or a 
nurse practitioner, in accordance with State law’’ 
after ‘‘physician’’. 
(3) ADMINISTRATION
OF
PART
B.—Section 
1842(b)(2)(C) of the Social Security Act (42 U.S.C. 
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1395u(b)(2)(C)) is amended by striking ‘‘working in 
collaboration with that physician’’. 
(4) PROVISION
OF
MEDICAL
AND
OTHER 
HEALTH
SERVICES.—Section 1861(s)(2)(K)(ii) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395x(s)(2)(K)(ii)) is amended by striking ‘‘or clin-
ical nurse specialist (as defined in subsection 
(aa)(5)) working in collaboration (as defined in sub-
section (aa)(6)) with a physician (as defined in sub-
section (r)(1))’’ and inserting ‘‘(as defined in sub-
section (aa)(5)(A)), or by a clinical nurse specialist 
(as defined in subsection (aa)(5)(B)) working in col-
laboration with a physician (as defined in subsection 
(r)(1)),’’. 
(b) MEDICAID.— 
(1) CERTIFICATION OF SKILLED NURSING FA-
CILITY SERVICES AND INTERMEDIATE CARE FACIL-
ITY SERVICES.—Section 1902(a)(44) of the Social 
Security Act (42 U.S.C. 1396a(a)(44)) is amend-
ed— 
(A) in subparagraph (A)— 
(i) by striking ‘‘a physician (or, in the 
case of skilled nursing facility services or’’ 
and inserting ‘‘a physician (or, in the case 
of skilled nursing facility services, a physi-
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cian or nurse practitioner; and, in the case 
of’’; and 
(ii) by striking ‘‘or, in the case of 
skilled nursing facility services or’’ and in-
serting ‘‘or, in the case of skilled nursing 
facility services, a physician or nurse prac-
titioner; and, in the case of’’; and 
(B) in subparagraph (B), by striking ‘‘a 
physician, or a nurse practitioner or clinical 
nurse specialist’’ and inserting ‘‘a physician or 
nurse practitioner, or a clinical nurse spe-
cialist’’. 
(2) NURSING FACILITY SERVICES SUPERVISION 
AND CLINICAL RECORDS.—Section 1919(b)(6)(A) of 
the Social Security Act (42 U.S.C. 1396r(b)(6)(A)) 
is amended to read as follows: 
‘‘(A) require that the health care of every 
resident be provided under the supervision of a 
physician or nurse practitioner (or, at the op-
tion of a State, under the supervision of a clin-
ical nurse specialist or physician assistant who 
is not an employee of the facility but who is 
working in collaboration with a physician);’’. 
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SEC. 108. AUTHORIZING MEDICARE AND MEDICAID INPA-
TIENT HOSPITAL PATIENTS TO BE UNDER 
THE CARE OF A NURSE PRACTITIONER. 
(a) MEDICARE.— 
(1) CERTIFICATIONS.—Section 1814(a)(3) of 
the Social Security Act (42 U.S.C. 1395f(a)(3)) is 
amended by inserting ‘‘or nurse practitioner’’ after 
‘‘physician’’ the first place that it appears. 
(2) PRIVILEGES FOR NURSE PRACTITIONERS.— 
Section 1861 of the Social Security Act (42 U.S.C. 
1395x) is amended— 
(A) in subsection (e)(4), by inserting ‘‘(or 
nurse practitioner, in accordance with State 
law)’’ after ‘‘physician’’; 
(B) in subsection (f)(1), by inserting ‘‘or 
nurse practitioner’’ after ‘‘physician’’; and 
(C) in subsection (ee)(2), by inserting ‘‘or 
nurse practitioner’’ after ‘‘physician’’ each place 
that it appears. 
(b) MEDICAID.—Section 1902(a)(44) of the Social 
Security Act (42 U.S.C. 1396a(a)(44)) is amended— 
(1) in paragraph (A), by inserting ‘‘or nurse 
practitioner’’ after ‘‘physician’’ the first place that it 
appears; and 
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(2) in paragraph (B), by inserting ‘‘or nurse 
practitioner’’ after ‘‘physician’’ the first place that it 
appears. 
SEC. 109. IMPROVING ACCESS TO MEDICAID CLINIC SERV-
ICES. 
Section 1905(a)(9) of the Social Security Act (42 
U.S.C. 1396d(a)(9)) is amended by adding ‘‘or nurse 
practitioner’’ after ‘‘physician’’ in both places that it ap-
pears. 
TITLE 
II—REMOVAL 
OF 
BAR-
RIERS TO PRACTICE ON CER-
TIFIED REGISTERED NURSE 
ANESTHETISTS 
SEC. 201. CLARIFYING THAT CERTIFIED REGISTERED 
NURSE ANESTHETISTS CAN BE REIMBURSED 
BY MEDICARE FOR EVALUATION AND MAN-
AGEMENT SERVICES. 
Section 1861(bb)(1) of the Social Security Act (42 
U.S.C. 1395x(bb)(1)) is amended by inserting ‘‘, including 
pre-anesthesia evaluation and management services,’’ 
after ‘‘and related care’’. 
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SEC. 202. REVISION OF CONDITIONS OF PAYMENT RELAT-
ING TO SERVICES ORDERED AND REFERRED 
BY CERTIFIED REGISTERED NURSE ANES-
THETISTS. 
Not later than 3 months after the date of enactment 
of this Act, the Secretary of Health and Human Services 
shall revise section 410.69 of title 42, Code of Federal 
Regulations, to clarify that, for purposes of payment 
under part B of title XVIII of the Social Security Act— 
(1) certified registered nurse anesthetists are 
authorized to order, certify, and refer services to the 
extent allowed under the law of the State in which 
the services are furnished; and 
(2) payment shall be made under such part for 
such services so ordered, certified, or referred by 
certified registered nurse anesthetists. 
SEC. 203. SPECIAL PAYMENT RULE FOR TEACHING STU-
DENT REGISTERED NURSE ANESTHETISTS. 
Section 1848(a)(6) of the Social Security Act (42 
U.S.C. 1395w–4(a)(6)) is amended in the matter pre-
ceding subparagraph (A), by inserting ‘‘or student reg-
istered nurse anesthetists’’ after ‘‘physician residents’’. 
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SEC. 204. REMOVING UNNECESSARY AND COSTLY SUPER-
VISION OF CERTIFIED REGISTERED NURSE 
ANESTHETISTS. 
Section 1861(bb)(2) of the Social Security Act (42 
U.S.C. 1395x(bb)(2)) is amended— 
(1) in the second sentence, by inserting ‘‘, but 
may not require that certified registered nurse anes-
thetists provide services under the supervision of a 
physician’’ after ‘‘certification of nurse anes-
thetists’’; and 
(2) in the third sentence, by inserting ‘‘under 
the supervision of an anesthesiologist’’ after ‘‘an an-
esthesiologist assistant’’. 
SEC. 205. CRNA SERVICES AS A MEDICAID-REQUIRED BEN-
EFIT. 
(a) IN GENERAL.—Section 1905(a)(5) of the Social 
Security Act (42 U.S.C. 1396d(a)(5)) is amended— 
(1) by striking ‘‘and (B)’’ and inserting ‘‘(B)’’; 
and 
(2) by inserting before the semicolon at the end 
the following: ‘‘, and (C) services furnished by a cer-
tified registered nurse anesthetist (as defined in sec-
tion 1861(bb)(2)), which such certified registered 
nurse anesthetist is authorized to perform under 
State law (or the State regulatory mechanism as 
provided by State law)’’. 
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(b) PAYMENT.—Section 1902(a) of the Social Secu-
rity Act (42 U.S.C. 1396d(a)) is amended— 
(1) in paragraph (86), by striking ‘‘and’’ at the 
end; 
(2) in paragraph (87), by striking the period 
and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (87) the fol-
lowing new paragraph: 
‘‘(88) provide for payment for the services of a 
certified registered nurse anesthetist (as defined in 
section 1861(bb)(1)) in amounts no lower than the 
amounts, using the same methodology, used for pay-
ment for amounts under section 1833(a)(1)(H).’’. 
TITLE III—REMOVAL OF BAR-
RIERS TO PRACTICE ON CER-
TIFIED NURSE-MIDWIVES 
SEC. 301. IMPROVING ACCESS TO TRAINING IN MATERNITY 
CARE. 
(a) MEDICARE PAYMENTS
FOR SUPERVISION
BY 
CERTIFIED NURSE-MIDWIVES.—Paragraph (1) of section 
1861(gg) of the Social Security Act (42 U.S.C. 1395x(gg)) 
is amended to read as follows: 
‘‘(1) The term ‘certified nurse-midwife services’ 
means— 
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