How the Improving Care and Access to Nurses (I CAN) Act Impacts Nurses

Advanced practice registered nurses (APRNs) demonstrated strength, versatility, and resilience during the pandemic, caring for patients in various settings. Yet, their education and clinical experience could have been extended further to improve access to healthcare if the legislation had allowed it. APRN care is tied to greater patient satisfaction, improved communication, and fewer emergency room visits.

Patient outcomes are similar between NPs and medical doctors, but in some cases, patients do better with an NP. To address this gap in care, Rep. Lucille Roybal-Allard (D-CA) and Rep. Dave Joyce (R-OH) introduced the I CAN Act (H.R. 8812) to the House of Representatives on September 13, 2022.

Discover what the I CAN Act is, how it impacts nurses, and the steps nurses and APRNs can take to improve access to healthcare across the country.

If passed, the legislation would remove barriers to nurse practitioner practice in the Medicare and Medicaid programs. It would increase access to services provided by the more than 200,000 APRNs currently practicing.

According to the American Association of Nurse Practitioners (AANP), around 40% of people who Medicare covers receive their healthcare from nurse practitioners. In 2016, nurse practitioners accounted for 25% of providers in rural areas, and 87% of nurse practitioners were certified in an area of primary care.

According to the AANP, the act authorizes nurse practitioners to provide care by removing outdated federal barriers. For example, it would allow NPs to refer patients for medical and nutritional therapy, certify and recertify terminal illness for hospice eligibility, and order and supervise cardiac and pulmonary rehabilitation.

These are just some of the healthcare processes and procedures that NPs are currently unable to provide to patients covered by Medicare and Medicaid. The legislation updates these programs to reflect modern practices and ensure patients receive the high-quality care they deserve from their chosen healthcare practitioner.

After the introduction to the House of Representatives, the bill was referred to the Committee on Energy and Commerce and the Committee on Ways and Means for consideration. Next, the bill must go before the House for a vote before it can be passed to the Senate.

If the legislation passes the House and Senate, it will go to the President for signature and finally become law. While this is a lengthy process, the legislation is getting strong support from nursing leadership.

The American Nurses Association (ANA), the AANP, the American College of Nurse-Midwives, and the American Association of Nurse Anesthesiology all support the I CAN Act.

They note the legislation is an important step to recognizing APRNs’ role in the nation’s healthcare system.

“The I CAN Act will improve our healthcare system, retire barriers to practice, and enable patients to receive timely access to healthcare from their chosen healthcare provider,” said AANP President April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN.

ANA President Ernest Grant, Ph.D., RN, FAAN, noted that nurses practiced at the top of their license during the pandemic when federal and state governments granted waivers so COVID-19 and nonCOVID-19 patients could have access to high-quality care.

He called the current federal regulations “antiquated barriers to practice” and said the I CAN Act would be a way for advanced practice nurses to care for patients with less interference and to the fullest extent of their education and abilities.

Nurse practitioners increase access to healthcare and provide patients with a wider choice. They also support positive patient outcomes and higher-ranking patient satisfaction. While the proposed legislation increases advanced practice nurses’ ability to provide care to Medicare and Medicaid beneficiaries, it does not address full-practice authority.

Instead, individual states govern those guidelines. The AANP tracks the state practice environment for APRNs across the U.S. and U.S. territories. Today, there are 29 states and territories with full-practice authority.

This means nurse practitioners can evaluate and diagnose patients, order and interpret tests, initiate and manage treatment, and prescribe medications and controlled substances.

For example, certified registered nurse anesthetists (CRNAs) often play an important role in maintaining access in rural hospitals as they are the predominant anesthesia provider in underserved communities. The proposed legislation improves reimbursement for CRNAs to evaluate and manage services for patients under Medicaid and Medicare.

Nurses are often more accessible than physicians and are a valuable asset in opening access to healthcare and improving health equity. Nurses also have an advantage in learning about how disparities affect the communities they serve.

Technology helps nurses and APRNs connect with patients and may help break communication barriers in nonEnglish-speaking populations. Consider including some of the following actions in your community to improve access to healthcare.