ICAN Act Would Expand Authority for Nurse Practitioners, APRNs

If enacted, a new bill would broaden the authority of Advanced Practice Registered Nurses (APRNs) to provide care to millions of Americans. HR 8812, referred to as the ICAN Act, would update current Medicaid and Medicare program rules. Although it would not give full practice authority, it would give nurse practitioners (NPs), nurse midwives, nurse anesthetists, and clinical nurse specialists the ability to perform duties currently reserved for physicians only.

Details of the ICAN Act

California representative Lucille Roybal-Allard (Democrat) and Ohio representative Dave Joyce introduced the bipartisan bill in the House on September 13, 2022. It now has the support of five other cosponsors from Illinois, Nebraska, Ohio, and Oregon. 

The legislation would expand treatment authority for APRNs across the country by removing practice barriers. That’s not to say that it would give them full practice authority. Today, only about half of the states’ licensure laws and practice acts allow NPs full practice authority. In other words, many state boards of nursing limit the ability of APRNs to evaluate, diagnose, order, and initiate and manage treatments. Advanced practice nurses will remain subject to state regulations.

However, the ICAN Act would remove barriers. NPs and other APRNs would be able to perform services that The Center for Medicare & Medicaid Services (CMS) now requires a physician to provide. 

Examples of services APRNs would be authorized to provide if Congress enacted this legislation include:

• Ordering and supervising cardiac/pulmonary rehabilitation

• Certifying diabetics for therapeutic shoes

• Including patients in ACOs under the MSSP 

• Referring patients for Medical Nutrition Therapy (MNT)

• Certifying and recertifying patients for hospice care

• Performing admitting assessments in Skilled Nursing Facilities (SNFs)

Even though these tasks fall under the scope of practice for many APRNs, some cannot provide them because of payer restrictions. 

Current Practice Restrictions

Many NPs report that payer policies significantly affect their ability to provide care to the fullest extent of their education and training. For many services, Medicare and Medicaid will only recognize a physician’s signature. 

Commercial insurance plans vary, but many do not recognize APRNs as primary care providers. Additionally, APRNs may have trouble getting credentialed with certain plans or receiving payment for their services. In some cases, services must be billed “incident to” a physician, meaning care is delivered under the physician.

In some cases, treatment is delayed for the most vulnerable patients. In underserved areas where access to doctors is limited, patients may not be able to get the referral, order, or treatment they need. Many states are seeing physician shortages unlikely to resolve in the next decade. Nurse practitioners could help mitigate this problem.

Need for Greater APRN Authority

According to the American Association of Nurse Practitioners (AANP), there are more than 355,000 currently licensed nurse practitioners, 89% of whom are certified in primary care, and 70% deliver primary care. Approximately 4 out of 5 see Medicare and Medicaid patients, demonstrating the need for expanded practice authority.

Medicare and Medicaid programs serve many disadvantaged groups, such as low-income seniors, minorities, the disabled, and rural residents of outlying areas known as “healthcare deserts.” Regulations prohibiting APRNs from ordering, certifying, and referring may prevent these groups from getting the care they need.

Support for the ICAN Act

Professional nursing organizations have been outspoken in support of HR 8812. American Association of Nurse Anesthesiology (AANA) president Angela Mund, DNP, CRNA, argued that allowing APRNs to practice to the full extent of their training and licensure will ensure that patients are put first. 

American Nurses Association (ANA) President Dr. Ernest Grant, Ph.D., RN, FAAN put it this way: “Modern health care requires flexibility. We cannot be hindered by antiquated barriers to practice or petty turf wars over perceived hierarchies. The health of our patients and communities must come first. The ICAN Act means that APRNs, including nurse practitioners, nurse anesthetists, nurse-midwives, and clinical nurse specialists, will be able to care for their patients to the fullest extent of their abilities while experiencing fewer disruptions and less interference.”

These sentiments align with the views of non-nursing healthcare providers, too. In a report titled “The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity,” the National Academy of Medicine recommended “enabling nurses to practice to the full extent of their education and training by removing practice barriers that prevent them from fully addressing their patients needs, which would improve healthcare access, quality, and value.”

How Nurses Can Support the Bill

Nurses who want to show support for this bill can contact their state legislators. An AANP campaign page provides a contact form that assists nurses in preparing an email template that urges their representatives to cosponsor the act. 

The Takeaway

Nurse midwives, nurse anesthetists, clinical nurse specialists and NPs play a critical role in our healthcare system. In some communities, they are the only source of healthcare delivery. The ICAN Act could remove practice restrictions affecting thousands of APRNs and lift barriers to care for millions of patients.