(photo via AANP)

Several bills have recently been introduced on a state and federal level that would expand the authority of Nurse Practitioners (NPs) and other Advanced Practice Registered Nurses (APRNs) if passed into law. 

H.R. 8812 (ICAN Act) and S.5212

H.R. 8812, also known as the ICAN Act, was introduced in the House of Representatives on September 13, 2022. The bill is sponsored by Representative Lucille Roybal-Allard (D-CA). It is supported by 13 cosponsors, 10 Democrats, and 3 Republicans.

A similar bill, S. 5212, was introduced in the Senate on December 8, 2022, by Senator Jeff Merkley (D-OR).

The ICAN Act would remove practice barriers for Nurse Practitioners by allowing them to provide more comprehensive healthcare services to patients across the country. If passed, H.R. 8812 and S. 5212 would allow NPs to perform duties previously reserved for physicians only due to payor restrictions, such as:

• Ordering and supervising cardiac and pulmonary rehabilitation

• Certifying when patients with diabetes need therapeutic shoes

• Having patients fully invested in the beneficiary attribution process for the Medicare Shared Savings Program

• Referring patients for medical nutrition therapy

• Certifying and recertifying a patient's terminal illness for hospice eligibility

• Performing all mandatory physical examinations in skilled nursing facilities

• Certifying the need for inpatient hospital services under Medicare/Medicaid

MO SB79 and MO HB271

MO SB79 was introduced in the Missouri State Senate on January 4, 2023. Its House counterpart, MO HB271, was introduced on the same day. These bills would grant full practice authority to NPs in Missouri, allowing them to work independently without physician oversight. 

Bills that propose a broader scope of practice for NPs are often met with resistance by physicians, and MO SB79/HB271 is no exception.

John Burroughs, Chairman of the Missouri Academy of Family Physicians, argued against the legislation, stating, “The amount of training that the nurse practitioners have to be practicing is far less, in some respects less than 10% of what a physician has, day to day. Routine types of visits and in some cases, very specialized visits within some specialties, mid-levels can do a wonderful job, but our education is driven on seeing as many things as we possibly can so that when things aren’t routine, we have that ability to have an idea of treatment or diagnosis, the quality of care can be decreased with a mid-level provider, just based on the education and training levels. Unfortunately, I just don’t see that independent nurse, nurse practitioner licensing is really going to fix the problem that we’re looking to fix, which is bringing more health care to those areas. For us, it’s not that we think that nurse practitioners provide care. It’s just that we certainly hope that the training that we go through for the physician route gives a lot more of that experience and a lot more quality of care to our patients.”

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Official Statements By Professional Organizations

American Association of Nurse Practitioners

The ICAN Act is supported by the American Association of Nurse Practitioners (AANP). “The ICAN Act will eliminate outdated barriers to care that impede the progress of our health care system," said AANP President April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN.

Regarding the prescriptive authority of Nurse Practitioners, the AANP also released the following position statement:

“The American Association of Nurse Practitioners® (AANP) recognizes that the scope and practice of a nurse practitioner (NP) include prescribing. Prescribing is not a distinct act outside of or differentiated from NP practice. It is the position of AANP that NP prescriptive authority is solely regulated by state boards of nursing and in accordance with the NP role, education, and certification. The authorization of NPs to prescribe legend and controlled medications, devices, health care services, durable medical equipment, and other equipment and supplies is essential to providing timely, cost-effective, quality health care.”

American Nurses Association

American Nurses Association President Ernest J. Grant, Ph.D., RN, FAAN released the following statement in response to the ICAN Act:

“The ICAN Act is a significant bill that will eliminate many of the burdensome laws and regulations that have prevented patients from getting access to the kind of timely, evidenced-based care that APRNs are clinically trained and qualified to provide. Allowing APRNs to practice at the top of their license, as they did during the height of the COVID-19 pandemic, will help to cultivate the kind of flexibility that modern health care requires. That flexibility will improve patient outcomes and lower costs. And in doing so it will ensure that more individuals, including those in rural and underserved communities, have access to the kind of health care that they deserve. APRNs have the demonstrated clinical expertise and track record to meet the complex demands of diverse patient populations, respond to public health challenges, and improve health equity. The ICAN Act is an overdue starting point to remove outmoded barriers to practice and hopefully end tiresome debates over hierarchies by placing the needs of patients first.”

American Association of Nurse Anesthesiology

The American Association of Nurse Anesthesiology (AANA) also supports the ICAN Act, which would remove physician supervision requirements of Certified Registered Nurse Anesthetists (CRNAs) and provide access to CRNA services under Medicaid.

AANA President Angela Mund, DNP, CRNA released the following statement: 

“As the only anesthesia providers in most rural hospitals, and the predominant providers in underserved communities, CRNAs play an important role in maintaining critical access in communities across the country. However, superfluous regulations serve as barriers to expanding care, especially at a time when those same communities face a shortage of providers. This critical legislation will help ensure that everyone who needs access to the high-quality care provided by advanced practice registered nurses such as CRNAs can have it. As a nurse anesthetist, I know firsthand how important it is to allow advanced practice registered nurses to work to the top of our education and scope. For more than two years Medicare has temporarily waived practice barriers to allow CRNAs and others to step up on the front lines of multiple global health challenges. We have seen how much nurses can do when we remove burdensome regulations and allow them to reach the full potential of their education and scope of practice.” 

National Academy of Medicine

In their 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.”

Current NP Restrictions

(photo via AANP)

Currently, only 26 states grant Nurse Practitioners full practice authority. With full practice authority, NPs can evaluate, diagnose, and treat patients without direct supervision by a physician. They are also free to prescribe medications without physician approval, including controlled substances

The remaining states either have reduced or restricted practice guidelines for NPs. These restrictions vary by state, but they usually require physician approval for many medical decisions. Every NP is responsible for understanding and abiding by the laws and limitations within their state of practice.

This current structure can create significant barriers to care for many Americans, including those on Medicare/Medicaid. The proposed legislation could alleviate some of the burden caused by the shortage of medical doctors and provide easier access to healthcare for millions of people.

Nurses who wish to support this legislation are encouraged to reach out to their members of Congress and make their voices heard. Contact information for U.S. House Representatives and Senators can be found here and here.