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With clinical staffing woes an ongoing concern, new Senate legislation seeks to expand the ability of advanced practice nurses (APRNs) to provide care with less oversight from physicians.

Sen. Jeff Merkley (D-OR) introduced the Improving Care and Access to Nurses (ICAN) Act on Thursday. It follows a House companion bill introduced in September. The legislation would remove Medicare and Medicaid laws and regulations that the legislators said prevent APRNs from practicing “the full scope of their education and clinical training.”

“Outdated” barriers to care

The legislation would eliminate outdated federal barriers to care, reported the American Association of Nurse Practitioners, which supports the bill. Specifically, it would authorize nurse practitioners to perform tasks such as providing all mandatory examinations in skilled nursing facilities, and ordering and supervising cardiac and pulmonary rehabilitation, for example.

It also would authorize APRNs to certify when patients with diabetes need therapeutic shoes, have their patients fully included in the beneficiary attribution process for the Medicare Shared Savings Program and recertify a patient’s terminal illness for hospice eligibility, among other things.

The American Nurses Association applauded the Senate support for the 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,” said ANA President Ernest J. Grant, PhD, RN, FAAN, in a Thursday statement.

Pandemic-era flexibilities

The idea is to allow APRNs to practice “at the top of their license,” with flexibilities similar to what they were allowed at the height of the pandemic, Grant said. He called the ICAN Act “an overdue starting point to remove outmoded barriers to practice, and hopefully end tiresome debates over hierarchies by placing the needs of patients first.”

More flexibility will improve patient outcomes and lower costs, and ensure that rural and underserved communities have access to healthcare, he added.

Physicians groups are less keen on the legislation, with many groups protesting the original House bill. Their argument is that it will result in removing physician involvement in patient care, McKnight’s Business Daily has reported.

Less oversight

APRNs have master or doctoral level education and provide primary, acute, chronic and specialty care. More than 200,000 advanced practice clinical nurses are treating Medicare patients, and approximately 40% of Medicare beneficiaries are receiving care from these professionals. 

The National Academy of Sciences (NAS) has advocated for removing practice barriers across all levels of nursing to expand patient access to care. According to the authors of a 2021 NAS report, “nurses at all levels and in all settings have the education, skills, experience and training to fill this critical care gap and address health disparities, if they are given the autonomy and institutional support to do so.”

The authors envisioned a scope of practice that would allow APRNs to prescribe medication, diagnose patients and provide treatment independent of a physician. They called for pandemic-era changes to scope of practice to become permanent in 2022.

In nursing homes, as part of the emergency blanket waivers passed during the pandemic, physicians were temporarily allowed to delegate some responsibilities to nurse practitioners and clinical nurse specialists, within the strictures of state laws. They were also given the flexibility to delegate their required in-person patient visits to the nurses. These flexibilities were later rescinded.

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