Congress expands nurse authority in Medicare, Medicaid—removing physician gatekeeping.

What it does

This bill expands Medicare and Medicaid coverage and reimbursement for services provided by advanced practice registered nurses—nurse practitioners, certified registered nurse anesthetists, and certified nurse-midwives—by removing restrictions that currently require physician supervision or limit their independent practice. It allows these nurses to order services, bill directly, and lead care teams in settings like skilled nursing facilities, hospice, and home health, subject to state law. The bill also strengthens transparency in Medicare's local coverage determination process and imposes penalties on contractors that impose unlawful practitioner-qualification restrictions.

Why we flagged it

The bill's core mechanism is removing statutory barriers to independent practice by advanced practice nurses in federal health programs. It is a deregulatory measure aimed at expanding care access, not a tax provision, appropriation, or commemorative act.

What the text implies

• Removes physician supervision requirements in skilled nursing facilities and hospice, potentially shifting care-team dynamics and liability exposure for facilities and insurers.
• Expands nurse practitioner authority to order and refer services under state law, creating a patchwork of coverage rules across states with varying nurse-practice acts.
• Local coverage determination transparency rules (Section 401) may increase administrative burden on Medicare contractors and slow coverage decisions if contractors must now disclose expert consultations and external communications.
• Medicaid payment parity for CRNAs (Section 205) ties reimbursement to physician fee schedule, potentially increasing state Medicaid costs if adoption rates rise.

Section numbers refer to the bill text the analysis read — linked under Primary records below.

Who it affects

Ordinary citizens gain expanded access to qualified advanced practice nurses in Medicare and Medicaid, potentially reducing wait times and out-of-pocket costs in underserved areas. The bill does not restrict citizen rights or remedies; it removes barriers to care delivery. Transparency improvements in local coverage determinations also strengthen public accountability.

Who stands to gain

• Advanced practice registered nurses (expanded billing and practice authority)
• Healthcare facilities (reduced physician supervision overhead)
• Patients in underserved areas (expanded access to care)

Named in the bill

Centers for Medicare & Medicaid Services (CMS), Medicare Administrative Contractors, Nurse Practitioners, Certified Registered Nurse Anesthetists (CRNAs), Certified Nurse-Midwives, Skilled Nursing Facilities, Hospice providers, Home health agencies, American Midwifery Certification Board, State medical boards and nursing boards

Where it stands

36 cosponsors: 25 Democrats, 11 Republicans.

• Feb 13, 2025 — Introduced · Congress.gov: “Introduced in House”
• Feb 13, 2025 — Referred to House Committee on Ways and Means and House Committee on Energy and Commerce · Congress.gov: “Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a…”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

15 lobbying clients named this bill on 25 disclosure filings across 3 quarters, Dec 2025 to Jun 2026. Those filings disclosed $8,798,360 in lobbying spend. A filing names 22 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 95% of bills with at least one filing.

David Joyce, the sponsor, reported $984,500 in PAC receipts in the 2026 cycle.

• American Medical Association — $5,643,000 on 2 filings
• American Association of Nurse Practitioners — $950,000 on 2 filings
• American Society of Anesthesiologists — $496,393 on 2 filings
• American Academy of Physician Associates — $320,000 on 2 filings
• American Association of Nurse Anesthetists — $275,000 on 1 filing

Lobbying Disclosure Act filings through Jul 22, 2026. A filing shows who paid to lobby on a bill it names, not what changed.