119-hr1317

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1317 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 1317

 To amend titles XVIII and XIX of the Social Security Act 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

 February 13, 2025

Mr. Joyce of Ohio (for himself, Ms. Bonamici, Mrs. Kiggans of Virginia, 
 Ms. Underwood, and Mr. Rogers of Alabama) introduced the following 
 bill; which was referred to the Committee on Energy and Commerce, and 
 in addition to the Committee 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 to increase 
 access 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 Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Improving Care and 
Access to Nurses Act'' or the ``I CAN Act''.

    (b) Table of Contents.--The table of contents of 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 and physician assistants 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 
 service Medicare program.

Sec. 105. Preserving access to home infusion therapy.

Sec. 106. Increasing access to hospice care services.

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.
 TITLE V--EFFECTIVE DATE

Sec. 501. Effective date.

 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.

    (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 
 setting''; and
        (B) in subparagraph
            (C) , by inserting after 
 ``physician'' the following: ``(as defined in 
 subsection

    (r)

    (1) ) or a physician assistant, nurse 
 practitioner, or clinical nurse specialist (as those 
 terms are defined in subsection

    (aa)

    (5) )'';

    (2) in paragraph

    (3)
        (A) , by striking ``physician-prescribed 
 exercise'' and inserting ``exercise prescribed by a physician 
 (as defined in subsection

    (r)

    (1) ) or a physician assistant, 
 nurse practitioner, or clinical nurse specialist (as those 
 terms are defined in subsection

    (aa)

    (5) )''; and

    (3) in paragraph

    (5) , by inserting after ``physician'' the 
 following: ``(as defined in subsection

    (r)

    (1) ) or a physician 
 assistant, nurse practitioner, or clinical nurse specialist (as 
 those terms are defined in subsection

    (aa)

    (5) )''.

    (b) Pulmonary Rehabilitation Programs.--

Section 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 prescribed by a physician 
 (as defined in subsection

    (r)

    (1) ) or a physician assistant, 
 nurse practitioner, or clinical nurse specialist (as those 
 terms are defined in subsection

    (aa)

    (5) )''; and

    (2) in paragraph

    (3) , by inserting after ``physician'' the 
 following: ``(as defined in subsection

    (r)

    (1) ) or a physician 
 assistant, nurse practitioner, or clinical nurse specialist (as 
 those terms are defined in subsection

    (aa)

    (5) )''.

SEC. 102. PERMITTING NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS TO 
 SATISFY MEDICARE DOCUMENTATION REQUIREMENT FOR COVERAGE 
 OF CERTAIN SHOES FOR INDIVIDUALS WITH DIABETES.

 

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 ``physician''; and

    (2) in subparagraph
            (C) , by inserting ``, nurse 
 practitioner, or physician assistant'' after each occurrence of 
 ``physician''.

SEC. 103. IMPROVEMENTS TO THE ASSIGNMENT OF BENEFICIARIES 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 subparagraph:
 ``
            (C) in the case of performance years beginning on 
 or after January 1, 2026, primary care services 
 provided under this title by an ACO professional 
 described in subsection

    (h)

    (1)
        (B) .''.

SEC. 104. EXPANDING THE AVAILABILITY OF MEDICAL NUTRITION THERAPY 
 SERVICE MEDICARE PROGRAM.

 

Section 1861
            (vv) (1) of the Social Security Act (42 U.S.C. 
1395x
            (vv) (1) ) is amended by inserting `` or a nurse practitioner, a 
clinical nurse specialist, or a physician assistant (as such terms are 
defined in subsection

    (aa)

    (5) )'' before the period at the end.

SEC. 105. PRESERVING ACCESS TO HOME INFUSION THERAPY.

    (a) Allowing Applicable Providers To Establish 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 subsection

    (r)

    (1) )'' and inserting ``an applicable provider (as defined in 
 paragraph

    (3)
        (A) )''; and

    (2) by striking ``a physician (as so defined)'' and 
 inserting ``an applicable provider (as so defined)''.

    (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 SERVICES.

    (a) In General.--

Section 1814

    (a)

    (7)
        (A) of the Social Security Act 
(42 U.S.C. 1395f

    (a)

    (7)
        (A) ) is amended--

    (1) in clause
            (i) --
        (A) in subclause
            (I) , by striking ``a nurse 
 practitioner or'';
        (B) in subclause
            (II) , by inserting ``or nurse 
 practitioner'' after ``physician''; and
            (C) in the flush matter following subclause
            (II) , 
 by inserting ``, nurse practitioner's,'' after 
 ``physician's''; and

    (2) 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 inserting ``or 
nurse practitioner'' after ``physician''.
            (c) Nurse Practitioner Billing.--Not later than 90 days after the 
date of the enactment of this Act, the Secretary of Health and Human 
Services shall revise 

section 418.304 of title 42, Code of Federal 
Regulations, to allow nurse practitioners to bill for services not 
described in paragraph

    (a) of such section in the same manner as 
physicians may bill for such services in accordance with paragraph

    (b) of such section. Such revision shall provide that such services 
furnished by a nurse practitioner shall be payable at the percent of 
the physician fee schedule specified in 

section 1833

    (a)

    (1)
        (O) of the 
Social Security Act (42 U.S.C. 1395l

    (a)

    (1)
        (O) ).

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.

    (a) Medicare.--

    (1) Certification of post-hospital extended care 
 services.--

Section 1814

    (a)

    (2) of the Social Security Act (42 
 U.S.C. 1395f

    (a)

    (2) ) is amended, in the matter preceding 
 subparagraph
        (A) , by striking ``, or a nurse practitioner,'' 
 and inserting ``or a nurse practitioner (in accordance with 
 State law), or''.

    (2) Certification authority for nurse practitioners.--
 

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''.

    (3) Supervision requirement in skilled nursing facility 
 services and resident's rights.--

Section 1819 of the Social 
 Security Act (42 U.S.C. 1395i-3

    (b)

    (6) ) is amended--
        (A) in subsection

    (b) --
            (i) in paragraph

    (2)
        (B) , by inserting ``or 
 nurse practitioner'' after ``attending 
 physician''; and
            (ii) in paragraph

    (6) --
            (I) in the heading, by striking 
 ``Physician supervision'' and inserting 
 ``Supervision''; and
            (II) in subparagraph
        (A) , by 
 inserting ``or a nurse practitioner, in 
 accordance with State law'' after 
 ``physician''; and
        (B) in subsection
            (c) --
            (i) in subparagraph

    (1)
        (A)
            (i) , by inserting 
 ``or nurse practitioner'' after ``attending 
 physician'';
            (ii) in the flush matter at the end of 
 subparagraph

    (2)
        (A) , by inserting ``or nurse 
 practitioner'' after ``physician'' in each 
 occurrence; and
            (iii) in subparagraph

    (3)
        (A) , by inserting 
 ``or nurse practitioner'' after ``physician''.

    (4) Administration of part b.--

Section 1842

    (b)

    (2)
            (C) of the 
 Social Security Act (42 U.S.C. 1395u

    (b)

    (2)
            (C) ) is amended, in 
 the second sentence--
        (A) by inserting ``or a nurse practitioner'' after 
 ``a physician''; and
        (B) by striking ``or a nurse practitioner working 
 in collaboration with that physician, or both''.

    (5) 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 clinical nurse 
 specialist (as defined in subsection

    (aa)

    (5) ) working in 
 collaboration (as defined in subsection

    (aa)

    (6) ) with a 
 physician (as defined in subsection

    (r)

    (1) )'' and inserting 
 ``(as defined in subsection

    (aa)

    (5)
        (A) ), or by a clinical nurse 
 specialist (as defined in subsection

    (aa)

    (5)
        (B) ) working in 
 collaboration with a physician (as defined in subsection

    (r)

    (1) ),''.

    (6) 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 each of subparagraphs
        (B) and
        (F) of 
 subsection

    (ee)

    (2) , by inserting ``or nurse 
 practitioner'' after ``physician''.

    (b) Medicaid.--

    (1) Certification authority for nurse practitioners.--
 

Section 1902

    (a)

    (44) of the Social Security Act (42 U.S.C. 
 1396a

    (a)

    (44) ) is amended to read as follows:
 ``

    (44) in each case for which payment for inpatient 
 hospital services, skilled nursing facility services, services 
 in an intermediate care facility described in 

section 1905
            (d) , 
 or inpatient mental hospital services is made under the State 
 plan--
 ``
        (A) a physician or nurse practitioner (or, in the 
 case of skilled nursing facility services or 
 intermediate care facility services, a physician or 
 nurse practitioner, or a clinical nurse specialist who 
 is not an employee of the facility but is working in 
 collaboration with a physician) certifies at the time 
 of admission, or, if later, the time the individual 
 applies for medical assistance under the State plan 
 (and a physician or nurse practitioner, or a physician 
 assistant under the supervision of a physician, or, in 
 the case of skilled nursing facility services or 
 intermediate care facility services, a physician or 
 nurse practitioner, or a clinical nurse specialist who 
 is not an employee of the facility but is working in 
 collaboration with a physician, recertifies, where such 
 services are furnished over a period of time, in such 
 cases, at least as often as required under 

section 1903

    (g)

    (6) (or, in the case of services that are 
 services provided in an intermediate care facility, 
 every year), and accompanied by such supporting 
 material, appropriate to the case involved, as may be 
 provided in regulations of the Secretary), that such 
 services are or were required to be given on an 
 inpatient basis because the individual needs or needed 
 such services, and
 ``
        (B) such services were furnished under a plan 
 established and periodically reviewed and evaluated by 
 a physician or nurse practitioner, or, in the case of 
 skilled nursing facility services or intermediate care 
 facility services, by a physician or nurse 
 practitioner, or a clinical nurse specialist who is not 
 an employee of the facility but is working in 
 collaboration with a physician;''.

    (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 option of a 
 State, under the supervision of a clinical nurse 
 specialist or physician assistant who is not an 
 employee of the facility but who is working in 
 collaboration with a physician);''.

SEC. 108. IMPROVING ACCESS TO MEDICAID CLINIC SERVICES.

 

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 appears.

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.

 

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''.

SEC. 202. REVISION OF CONDITIONS OF PAYMENT RELATING TO SERVICES 
 ORDERED AND REFERRED BY CERTIFIED REGISTERED NURSE 
 ANESTHETISTS.

 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 STUDENT 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 preceding subparagraph
        (A) , by 
inserting ``or student registered nurse anesthetists'' after 
``physician residents''.

SEC. 204. REMOVING UNNECESSARY AND COSTLY SUPERVISION 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 anesthetists provide 
 services under the supervision of a physician'' after 
 ``certification of nurse anesthetists''; and

    (2) in the third sentence, by inserting ``under the 
 supervision of an anesthesiologist'' after ``an 
 anesthesiologist assistant''.

SEC. 205. CRNA SERVICES AS A MEDICAID-REQUIRED BENEFIT.

    (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 certified 
 registered nurse anesthetist (as defined in 

section 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)''.

    (b) Payment.--

Section 1902

    (a) of the Social Security 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 following 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 payment for amounts under 

section 1833

    (a)

    (1)
        (H) .''.

 TITLE III--REMOVAL OF BARRIERS TO PRACTICE ON CERTIFIED 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--
 ``
        (A) such services furnished by a certified nurse-
 midwife (as defined in paragraph

    (2) ); and
 ``
        (B) such services (and such supplies and services 
 furnished as an incident to the nurse-midwife's 
 service) which--
 ``
            (i) the certified nurse-midwife is 
 legally authorized to perform under State law 
 (or the State regulatory mechanism provided by 
 State law) as would otherwise be covered if 
 furnished by a physician;
 ``
            (ii) are furnished under the supervision 
 of a certified-nurse midwife by an intern or 
 resident-in-training (as described in 
 subsection

    (b)

    (6) );
 ``
            (iii) would otherwise be described in 
 subparagraph
        (A) if furnished by a certified 
 nurse-midwife; and
 ``
            (iv) would otherwise be covered if 
 furnished under the supervision of a 
 physician.''.

    (b) Clarifying Permissibility of Using Certain Grants for Clinical 
Training by Certified Nurse-Midwives.--

Section 811

    (a)

    (1) of the Public 
Health Service Act (42 U.S.C. 296j

    (a)

    (1) ) is amended by inserting ``, 
including clinical training,'' after ``projects''.

SEC. 302. IMPROVING MEDICARE PATIENT ACCESS TO HOME HEALTH SERVICES 
 PROVIDED BY CERTIFIED NURSE-MIDWIVES.

    (a) In General.--

Section 1835

    (a) of the Social Security Act (42 
U.S.C. 1395n

    (a) ) is amended--

    (1) in paragraph

    (2) --
        (A) in the matter preceding subparagraph
        (A) , by 
 inserting ``or a certified nurse-midwife (as defined in 
 

section 1861

    (gg) ),'' after ``or a physician assistant 
 (as defined in 

section 1861

    (aa)

    (5) ) who is working in 
 accordance with State law,''; and
        (B) in subparagraph
        (A) --
            (i) in each of clauses
            (ii) and
            (iii) , by 
 striking ``or a physician assistant (as the 
 case may be)'' and inserting ``a physician 
 assistant, or a certified nurse-midwife (as the 
 case may be)''; and
            (ii) in clause
            (iv) , by--
            (I) inserting ``or by a certified 
 nurse-midwife (as defined in 

section 1861

    (gg) )'' after ``(but in no case 
 later than the date that is 6 months 
 after the date of the enactment of the 
 CARES Act)''; and
            (II) by striking ``(as defined in 
 

section 1861

    (gg) )''; and

    (2) in the matter following paragraph

    (2) , by striking ``or 
 physician assistant (as the case may be)'' and inserting 
 ``physician assistant, or certified nurse-midwife (as the case 
 may be)'' each place it appears.

    (b) Conforming Amendments.--

Section 1895 of the Social Security Act 
(42 U.S.C. 1395

    (fff) ) is amended--

    (1) in subsection
            (c) (1) , by inserting ``the certified 
 nurse-midwife (as defined in 

section 1861

    (gg) ),'' after 
 ``clinical nurse specialist (as those terms are defined in 
 

section 1861

    (aa)

    (5) ),''; and

    (2) in subsection

    (e)

    (1)
        (A) , by striking ``a physician a 
 nurse practitioner or clinical nurse specialist,'' and 
 inserting ``a physician, a nurse practitioner, a clinical nurse 
 specialist, a certified nurse-midwife,''.

SEC. 303. IMPROVING ACCESS TO DMEPOS FOR MEDICARE BENEFICIARIES.

 

Section 1834

    (a) of the Social Security Act (42 U.S.C. 1395m

    (a) ) is 
amended--

    (1) in paragraph

    (1)
        (E)
            (ii) by striking ``or a clinical 
 nurse specialist (as those terms are defined in 

section 1861

    (aa)

    (5) )'' and inserting ``, a clinical nurse specialist 
 (as those terms are defined in 

section 1861

    (aa)

    (5) ), or a 
 certified nurse-midwife (as defined in 

section 1861

    (gg) )''; and

    (2) in paragraph

    (11)
        (B)
            (ii) --
        (A) by striking ``or a clinical nurse specialist 
 (as those terms are defined in 

section 1861

    (aa)

    (5) )'' 
 and inserting ``a clinical nurse specialist (as those 
 terms are defined in 

section 1861

    (aa)

    (5) ), or a 
 certified nurse-midwife (as defined in 

section 1861

    (gg) )''; and
        (B) by striking ``or specialist'' and inserting 
 ``specialist, or nurse-midwife''.

SEC. 304. TECHNICAL CHANGES TO QUALIFICATIONS AND CONDITIONS WITH 
 RESPECT TO THE SERVICES OF CERTIFIED NURSE-MIDWIVES.

 

Section 1861

    (gg)

    (2) of the Social Security Act (42 U.S.C. 
1395x

    (gg)

    (2) ) is amended by striking ``, or has been certified by an 
organization recognized by the Secretary'' and inserting ``and has been 
certified by the American Midwifery Certification Board (or a successor 
organization)''.

 TITLE IV--IMPROVING FEDERAL HEALTH PROGRAMS FOR ALL ADVANCED PRACTICE 
 REGISTERED NURSES

SEC. 401. REVISING THE LOCAL COVERAGE DETERMINATION PROCESS UNDER THE 
 MEDICARE PROGRAM.

    (a) In General.--

Section 1862
            (l) (5) of the Social Security Act (42 
U.S.C. 1395y
            (l) (5) ) is amended--

    (1) in subparagraph
            (D) , by adding at the end the following 
 new clauses:
 ``
            (vi) Identification of any medical or 
 scientific experts whose advice was obtained by 
 such contractor during the development of such 
 determination, whether or not such contractor 
 relied on such advice in developing such 
 determination.
 ``
            (vii) A hyperlink to any written 
 communication between such contractor and 
 another entity that such contractor relied on 
 when developing such determination.
 ``
            (viii) A hyperlink to any rule, 
 guideline, protocol, or other criterion that 
 such contractor relied on when developing such 
 determination.''; and

    (2) by adding at the end the following new subparagraphs:
 ``
        (E) Prohibition on imposition of practitioner 
 qualifications.--The Secretary shall prohibit a 
 Medicare administrative contractor that develops a 
 local coverage determination from imposing such 
 determination on any coverage limitation with respect 
 to the qualifications of a physician (as defined in 
 

section 1861

    (r) ) or a practitioner described in 

section 1842

    (b)

    (18)
            (C) who may furnish the item or service that 
 is the subject of such determination.
 ``
        (F) Civil monetary penalty.--A Medicare 
 administrative contractor that develops a local 
 coverage determination that fails to make information 
 described in subparagraph
            (D) available as required by 
 the Secretary under such subparagraph or comply with 
 the prohibition under subparagraph
        (E) is subject to a 
 civil monetary penalty of not more than $10,000 for 
 each such failure. The provisions of 

section 1128A 
 (other than subsections

    (a) and

    (b) ) shall apply to a 
 civil money penalty under the previous sentence in the 
 same manner as such provisions apply to a penalty or 
 proceeding under 

section 1128A

    (a) .''.

    (b) Timing of Review.--

Section 1869

    (f)

    (2) of the Social Security 
Act (42 U.S.C. 1395ff

    (f)

    (2) ) is amended by adding at the end the 
following new subparagraph:
 ``
            (D) Timing of review.--An aggrieved party may 
 file a complaint described in subparagraph
        (A) with 
 respect to a local coverage determination on or after 
 the date that such determination is posted, in 
 accordance with 

section 1862
            (l) (5)
            (D) , on the Internet 
 website of the Medicare administrative contractor 
 making such determination, whether or not such 
 determination has taken effect.''.
            (c) Effective Date.--The amendments made by this section shall 
apply to local coverage determinations made available on the internet 
website of a Medicare administrative contractor and on the Medicare 
internet website on or after the date of the enactment of this Act.

SEC. 402. LOCUM TENENS.

 

Section 1842

    (b)

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

    (b)

    (6) ) is amended, in the first sentence--

    (1) by striking ``and
        (J) '' and inserting ``
        (J) ''; and

    (2) by inserting before the period at the end the 
 following: ``, and
        (K) in the case of services furnished by a 
 certified registered nurse anesthetist (as defined in 

section 1861

    (bb)

    (2) ), nurse practitioner, or clinical nurse specialist 
 (as defined in 

section 1861

    (aa)

    (5) ), or a certified nurse 
 midwife (as defined in 

section 1861

    (gg)

    (2) ), subparagraph
            (D) of this sentence shall apply to such services and such 
 anesthetist, practitioner, specialist, or nurse-midwife in the 
 same manner as such subparagraph applies to physicians' 
 services furnished by physicians''.

 TITLE V--EFFECTIVE DATE

SEC. 501. EFFECTIVE DATE.

 The provisions of, including the amendments made by, this Act 
(other than sections 103 and 401) shall apply with respect to items and 
services furnished on or after the date that is 90 days after the date 
of the enactment of this Act. Notwithstanding any other provision of 
law, the Secretary of Health and Human Services shall implement such 
provisions, including such amendments, through interim final rule or 
subregulatory guidance if the Secretary determines such implementation 
to be necessary for purposes of complying with the preceding sentence 
or with any other effective date provided in this Act.
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