Executive Order for Medicare Accelerates APRN Reforms and CMS Delivers


Last week’s Capitol Beat offered a 10,000-foot review of the Administration’s Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors. This week, we take a deeper dive and connect the dots with ANA advocacy and a new success story expanding scope for advance practice registered nurses (APRNs) in Medicare.

Among other provisions, the Executive Order directs the federal Medicare agency to remove certain billing rules that can get in the way of providers caring for their patients. The initiative specifically targets Medicare practice rules that are more stringent than state laws. Medicare must propose new rules within a year’s time. This is welcome news for many APRNs participating in Medicare, who are subject to an array of confusing federal rules that keep them from practicing at the top of their profession in caring for Medicare beneficiaries.

ANA has long advocated for administrative reforms to lift separate Medicare practice restrictions on APRNs, who are subject to state licensing authorities where they practice. Most recently, in a letter to Medicare officials on September 24, 2019, ANA emphasized that federal payment rules applied to APRNs should not have the effect of restricting patient access and choice, and that Medicare beneficiaries are increasingly relying on APRNs for primary care. We also cautioned that federal restrictions on APRN practice can have systemic consequences, especially in rural, underserved, and appointment shortage areas, where new approaches are sorely needed to improve access and care experience.  

We are therefore excited to see signs in the Executive Order that nurses’ voices are being heard when it comes to health care reform. ANA and our members look forward to engaging with Medicare in the months ahead to identify some of the most troublesome barriers to APRN practice.

It is also encouraging to see that Medicare is already taking small steps to dismantle barriers to APRN care. The Centers for Medicare and Medicaid (CMS), starting next year, will allow nurse practitioners (NPs) in the state of Maryland to certify when their patients need home health care. This is a significant waiver of current law which requires an NP to bring in a physician, even when they are qualified under state practice authority to make such a decision.

The home health certification waiver in Maryland relates to a larger pilot program, which is testing a new payment system for Medicare in that state. Because of this pilot, CMS is able to authorize changes to existing law that are limited to the Maryland pilot. An act of Congress will be required to change the rules for the rest of the country. ANA supports the bipartisan Home Health Care Planning Improvement Act (H.R. 2150 / S. 296), which will allow NPs, clinical nurse specialists (CNSs), and certified nurse midwives (CNMs) to order home health care services without physician approval.

There is much work to be done to craft appropriate policies that expand access to APRN care and reward APRNs for the high-quality care they provide. ANA acknowledges and applauds the commitment of federal partners who are working with nurses to bring about the best possible results for our members and their patients.

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