Congress expands nurse practitioner power, removes physician gatekeeping in Medicare.

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 where and how these professionals can practice. It allows them to independently order services, bill for care, and lead patient teams in hospitals, nursing facilities, and home settings, 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 operative mechanism is to expand scope-of-practice and billing authority for advanced practice nurses across Medicare and Medicaid. It is not a tax measure, appropriation, or narrow carve-out; it is a broad regulatory reform aimed at increasing access to care.

What the text implies

• Removes physician supervision requirements in skilled nursing facilities and hospice, potentially reducing physician oversight of patient safety in high-acuity settings; compliance depends entirely on state law and facility protocols.
• Expands nurse practitioner authority to order and refer services without physician involvement, shifting clinical decision-making authority; quality and safety outcomes will depend on nurse practitioner training, credentialing, and state regulatory standards.
• Local coverage determination (LCD) reforms prohibit Medicare contractors from imposing practitioner-qualification restrictions, potentially overriding contractor expertise in determining which providers are qualified for specific services in specific regions.
• Medicaid payment requirement (Section 205) mandates state payment for CRNA services at Medicare rates, creating a federal floor that may strain state budgets if states cannot negotiate lower rates.
• Effective date is 90 days post-enactment, with interim final rule authority for HHS, allowing rapid implementation without full notice-and-comment rulemaking; implementation details and state-law coordination will be critical.

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 healthcare providers in underserved areas and settings (home health, nursing facilities, hospice), potentially reducing wait times and out-of-pocket costs. The bill does not restrict any citizen right or remedy; it removes barriers to care. Physicians lose some gatekeeping authority, but that is a redistribution of professional power, not a cost to the public.

Who stands to gain

• advanced practice registered nurses (expanded billing and practice authority)
• nurse practitioner employers and staffing agencies
• certified registered nurse anesthetists
• certified nurse-midwives
• home health agencies (expanded provider pool)
• nursing facilities and skilled nursing facilities (expanded staffing options)

Named in the bill

Medicare, Medicaid, Social Security Act (Titles XVIII and XIX), Department of Health and Human Services (HHS), Medicare administrative contractors, American Midwifery Certification Board, State health regulatory boards, Nurse practitioners, Certified registered nurse anesthetists (CRNAs), Certified nurse-midwives, Physician assistants, Clinical nurse specialists

Where it stands

6 cosponsors: 5 Democrats, 1 Republicans.

• Feb 13, 2025 — Introduced · Congress.gov: “Introduced in Senate”
• Feb 13, 2025 — Referred to Senate Committee on Finance · Congress.gov: “Read twice and referred to the Committee on Finance”

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

Money around this bill

13 lobbying clients named this bill on 22 disclosure filings across 3 quarters, Dec 2025 to Jun 2026. Those filings disclosed $2,618,967 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 94% of bills with at least one filing.

Jeff Merkley, the sponsor, reported $514,925 in PAC receipts in the 2026 cycle.

• American Association of Nurse Practitioners — $950,000 on 2 filings
• American Academy of Physician Associates — $320,000 on 2 filings
• American Association of Nurse Anesthetists — $275,000 on 1 filing
• American Nurses Association — $270,000 on 1 filing
• Emergency Nurses Association — $140,900 on 3 filings

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