Joyce, Bonamici, Underwood, and Kiggans Reintroduce Bipartisan Bill to Increase Access to Nurses

Apr 24, 2023
Health Care

WASHINGTON, DC – Today, Congressman Dave Joyce (OH-14), Congresswoman Suzanne Bonamici (OR-01), Congresswoman Lauren Underwood (IL-14), and Congresswoman Jennifer Kiggans (VA-02) re-introduced the Improving Care and Access to Nurses (I CAN) Act. This bipartisan legislation would increase healthcare access, improve quality of care, and lower costs by removing the remaining barriers imposed by the federal government in the Medicare and Medicaid programs that prevent Advance Practice Registered Nurses (APRNs) from practicing the full scope of their education and clinical training. Additional co-sponsors of the bill include Representatives Jan Schakowsky (IL-09), Kelly Armstrong (ND-AL), Earl Blumenauer (OR-03), Adrian Smith (NE-03), Glenn Grothman (WI-06), Chris Pappas (NH-01) and Ann McLane Kuster (NH-02).

“Nurses are on the frontlines of the effort to ensure that Americans have access to the healthcare they need, but outdated federal restrictions are limiting patients’ access to care,” said Congressman Joyce, Co-Chair of the Congressional Nursing Caucus. “By removing these unnecessary federal barriers that prevent Advanced Practice Registered Nurses from carrying out their duties, our bipartisan bill will increase access to care and strengthen patient choice. That’s why I am proud to join this effort with my colleagues to expand access to care, lower patient costs, and ensure every Ohioan can receive services from the healthcare provider of their choice.”

“Nurse practitioners and other advanced practice registered nurses provide a vast range of quality care, but their ability to serve patients on Medicare and Medicaid is unfairly constrained by outdated restrictions. The Improving Care and Access to Nursing Act (I CAN Act) will remove barriers and allow nurses to care for more patients, which will improve care and reduce costs. I’m pleased to introduce this bipartisan legislation with my Nursing Caucus colleagues Reps. Joyce, Underwood, and Kiggans,” said Congresswoman Bonamici, Co-Chair of the Congressional Nursing Caucus.

“As a registered nurse and vice chair of the Congressional Nursing Caucus, I’m focused on ensuring Advance Practice Registered Nurses can practice to the full extent of their education and training,” said Congresswoman Underwood, Vice Chair of the Congressional Nursing Caucus. “The evidence is clear: lifting practice barriers for APRNs is safe and makes financial sense. I’m pleased to join my colleagues in introducing the I CAN Act to remove outdated barriers to practice for APRNs and expand access to high-quality health care.”

“As a nurse practitioner, it has always frustrated me that Medicare and Medicaid programs have barriers in place that prevent nurses from caring for patients to the full extent of their abilities,” said Congresswoman Kiggans (VA-02), Vice Chair of the Congressional Nursing Caucus. “Limiting the care our nurses can provide is the last thing we should be doing when our nation is facing a healthcare worker shortage. That’s why I’m proud to introduce the ICAN Act. By removing the federal barriers that prohibit nurses from practicing to the full scope of their education and training, this bipartisan bill will expand access to healthcare, reduce costs for patients, and ensure all Virginians can receive the high-quality care they deserve.”

“Workforce shortages throughout the long-term care sector have already strained older adults’ and families’ access to critical services and supports—and demand will only grow as America’s population rapidly ages. By expanding the scope of practice for Advanced Practice Registered Nurses (APRNs) in hospice, skilled nursing and other critical areas, the Improving Care and Access to Nurses (I-CAN) Act removes current barriers that inhibit the efficient use of the valuable APRN workforce and expands APRNs’ impact, which will improve older adults and families’ ability to get the care they need. We applaud the work of the Congressional Nursing Caucus and thank Reps Joyce, Bonamici, Underwood, and Kiggans for their leadership of the Caucus and on this important legislation. Solving the aging services workforce crisis requires action on all fronts; we appreciate this bill’s contribution,” said Katie Smith Sloan, president and CEO, LeadingAge, the association of nonprofit providers of aging services.

“AANA thanks Representatives Joyce, Bonamici and the Congressional Nursing Caucus for introducing theImproving Care and Access to Nurseslegislation. As the only anesthesia provider in most rural hospitals, and the predominant provider in underserved communities, Certified Registered Nurse Anesthetists (CRNAs) play an important role in maintaining critical access in communities across the country. Yet unnecessary regulations serve as barriers to expanding care, especially at a time when those same communities face a shortage of providers. This critical legislation is an answer to workforce shortages in healthcare, as it will reduce barriers to help ensure that everyone who needs access to the high-quality care Advance Practice Registered Nurses such as CRNAs provide, can have it,” said AANA President Angela Mund, DNP, CRNA.

“The American College of Nurse-Midwives applauds the introduction of legislation that recognizes the critical role midwives and APRNs play in providing high-quality health care throughout the lifespan. We are especially grateful for the recognition of the valuable role of midwives as educators to obstetric and gynecologic learners in our nation’s medical teaching facilities, as interprofessional collaboration is key to improving and preventing maternal mortality and morbidity. It is critical that health policy, laws, and regulations facilitate the most efficient relationships between health care professionals and create systems in which midwives and other APRNs can communicate openly, practice collaboratively, and provide quality care. The Improving Care and Access to Nurses Act ensures that certified nurse-midwives can bring their evidenced-based skillset and knowledge to fully meet the needs of their patients,” stated ACNM President, Heather Clarke, DNP, CNM, APRN, LM, FACNM

“The American Association of Nurse Practitioners (AANP) applauds the introduction of the ICAN Act. This legislation will improve our health care system, retire barriers to practice, and enable patients to receive timely access to high-quality care from their chosen health care provider. Nurse practitioners (NPs) practice in nearly every health care setting and provide high-quality care to patients across the life span. The millions of patients who choose NPs as their health care providers should have equitable access to the health care they deserve. The ICAN Act will move health care delivery forward for patients, providers and our nation,” said AANP President April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN.

“The ICAN Act will improve care for millions of Americans by updating the Medicare and Medicaid programs and enabling APRNs to practice to the top of their education and clinical training, like they did at the height of the COVID-19 pandemic. The patients and communities being served by these nurses will get improved access to care, from the provider of their choice. This is especially true for those living in underserved communities who are often faced with a shortage of providers. By removing these significant legislative barriers, the ICAN Act marks an important step towards creating a more efficient, effective, and equitable health care delivery system. I want to thank Rep. Joyce, Rep. Bonamici, Rep. Underwood, and Rep. Kiggans for introducing this bill and for their commitment to nurses and the nursing profession,” said ANA President Jennifer Mensik Kennedy, PhD, MBA, RN, NEA-BC, FAAN.

“On behalf of the Hospice & Palliative Nurses Association (HPNA), we commend Reps. Joyce, Bonamici, Kiggans, and Underwood on reintroducing the Improving Care and Access to Nurses (ICAN) Act. This bill would greatly help hospice and palliative nurses, particularly APRNs, better care for patients and their families by improving access to the highest level of treatment and dignity, including at the end of life. The ICAN Act is essential in supporting the health and welfare of communities throughout the country, and we look forward to working with policymakers and stakeholders to help advance this important legislation,” said Michelle Webb, DNP, RN, CHPCA, President, HPNA and Ginger Marshall, MSN, ACNP-BC, ACHPN, FPCN, CEO, HPNA.

“The National Rural Health Association applauds Rep. Dave Joyce (R-OH) for re-introduction of H.R. 2713, the Improving Care and Access to Nurses (ICAN) Act. This important legislation eliminates barriers that prevent Advanced Practice Registered Nurses (APRN) from practicing at the full scope of their practice authority under state law and would grant APRNs full practice authority to care for patients insured under Medicare and Medicaid program. It would help alleviate the workforce shortages that burden many rural health providers. NRHA looks forward to working with Congress towards solutions for workforce shortages,” stated the NRHA.

APRNs are nurses prepared at the master or doctoral level to provide primary, acute, chronic and specialty care to patients of all ages and backgrounds, and in all settings. Their qualifications enable them to treat and diagnose illnesses, advise the public on health issues, manage chronic disease, order and interpret diagnostic tests, prescribe medication, and direct non-pharmacologic treatments for their patients. Over 40 years of vigorous, peer reviewed research has verified the safety, quality, satisfaction and cost-effectiveness of APRN care. This has led the National Academy of Sciences to call for the removal of laws, regulations, and policies that prevent APRNs from providing the full scope of health care services they are educated and trained to provide. 

Currently, several federal statutes and regulations, as well as certain state practice acts and institutional rules, require physician oversight and limit APRN practice. These barriers reduce access to care, create disruptions in care, increase the cost of care, and undermine efforts to improve the quality of care. Specifically, the I CAN Act would remove remaining barriers in the Medicare and Medicaid programs that prevent APRNs from practicing to the full extent of their education and clinical training. Importantly, this bill does not expand scope of practice or impede upon state law. Rather, the bill simply ensures that the federal government honors state law, ensuring that Medicare and Medicaid patients living in states where nurses have already been granted full practice authority are permitted to choose to seek care from a nurse practitioner. 

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