NURS 834 Week 6 Position Paper on the I CAN Act (H.R. 1317) Example

In Support of H.R. 1317, the Improving Care and Access to Nurses Act: A DNP's Position on Removing Medicare and Medicaid Barriers to Advanced Practice Registered Nurse Practice

Introduction

Mrs. A., an 84-year-old woman with end-stage heart failure in a rural county, had chosen hospice after a long conversation with her family and her pastor. Her nurse practitioner, who had cared for her for six years and knew her wishes, could not certify her terminal illness for the Medicare hospice benefit; federal rules required a physician. The nearest physician who knew her was out of town, and her admission to hospice was delayed four days, during which she was hospitalized once more. The nurse practitioner was licensed by the state to make the clinical judgment. Federal payment rules were the only obstacle.

This paper supports H.R. 1317, the Improving Care and Access to Nurses Act, which would remove barriers of this kind across Medicare and Medicaid. It describes the bill, analyzes it on policy, legal and ethical grounds, answers the strongest objections and considers the bill from a Christian worldview as it relates to the DNP role.

The Bill

H.R. 1317 was introduced in the House on February 13, 2025, by Ohio Representative David Joyce, joined by cosponsors from both parties, and a companion bill, S. 575, was introduced in the Senate the same day (Improving Care and Access to Nurses Act, 2025). In the House it sits with Energy and Commerce and with Ways and Means, where it has gathered 36 cosponsors without a committee vote as of this writing; the Senate version went to Finance.

The bill has four substantive titles. Title I removes barriers for nurse practitioners and, in several sections, clinical nurse specialists and physician assistants: it allows them to order and supervise cardiac and pulmonary rehabilitation, document the need for therapeutic shoes for patients with diabetes, provide medical nutrition therapy, establish home infusion therapy plans, certify and manage hospice care and certify and attend patients in skilled nursing facilities and Medicaid nursing facilities, in each case as permitted by state law. Title II addresses certified registered nurse anesthetists, including removal of the federal physician supervision requirement. Title III addresses certified nurse-midwives, including home health certification and durable medical equipment. Title IV applies to all advanced practice registered nurses, requiring transparency in how Medicare contractors make local coverage determinations, prohibiting practitioner-type limitations in those determinations and extending locum tenens arrangements to advanced practice nurses.

Policy Analysis

The policy question is whether removing these barriers would improve access without harming quality or raising costs. The evidence supports the bill. An integrative review of 13 studies on nurse practitioner state practice regulation found that, at a minimum, full practice authority does not worsen health outcomes and positively influences workforce migration, retention and provider-to-patient ratios (Pitts & Lindley, 2026). Koyuncu and colleagues, synthesizing 27 studies in 2026, reported that loosening regulation, particularly full practice authority, went with better access, a larger nurse practitioner presence where clinicians are scarce and fewer hospital admissions, but also that these benefits depended on whether legal authority was matched by billing and reimbursement, credentialing and organizational integration (Koyuncu et al., 2026). That second finding speaks directly to the I CAN Act. Many states have already granted full practice authority, yet federal payment rules still prevent nurse practitioners from doing what state law allows. The bill aligns federal billing with state authority, which is exactly the integration the review identified as necessary.

Cost and quality evidence is also reassuring. In 14 states that pay nurse practitioners at the Medicaid physician rate, adults with diabetes received comparable quality of primary care from nurse practitioners and physicians at similar cost (Harrison et al., 2023). Waxman (2018) treats reimbursement as part of the financial case for advanced practice nursing, and the logic applies here: when advanced practice nurses cannot bill for services they provide, organizations either duplicate work by routing it through a physician or forgo the service. The bill's effect on cost is therefore likely to be neutral or favorable, because it removes duplicate visits and delays like Mrs. A.'s readmission.

Legal Analysis

Legally, the bill is modest in an important way: it does not expand scope of practice. Each of its Medicare and Medicaid provisions applies to the extent permitted by state law, leaving states in control of what advanced practice nurses may do. The bill changes who may be paid by federal programs for services a state already allows. The bill also does not alter malpractice liability, prescriptive authority for controlled substances or the credentialing decisions hospitals make; organizations remain free to set their own medical staff rules. Its most significant legal changes are the removal of the federal supervision requirement for nurse anesthetists, which would defer to states that already permit independent practice, and the restrictions on how Medicare contractors limit coverage by practitioner type, which would subject those decisions to transparency and appeal. These changes respect the federal-state balance in health care regulation rather than overriding it.

Ethical Analysis

Two principles favor the bill. Justice requires that patients have fair access to care, and current federal barriers fall hardest on rural and underserved patients, where nurse practitioners are often the only clinicians available. Beneficence requires acting for patients' good, and rules that delay hospice, home health or cardiac rehabilitation for patients whose qualified clinician is an advanced practice nurse work against that good without a safety rationale. Respect for persons also supports the bill: patients who have chosen a nurse practitioner as their primary clinician should not have that choice overridden by payment rules when their care becomes complex. A rule that lets a nurse practitioner care for a patient for six years but not sign the hospice form in the seventh protects no one.

Opposing Views and Responses

The strongest objection is that advanced practice nurses have less training than physicians and that removing oversight could harm patients, particularly in complex settings such as skilled nursing facilities. This concern deserves respect. The response is that the bill does not remove state oversight or change state scope; it applies only where states have already judged advanced practice nurses competent. The evidence from states with full practice authority does not show worse outcomes (Pitts & Lindley, 2026).

A second objection concerns nurse anesthetists, where opponents argue that physician supervision protects patients during anesthesia. Here again the bill defers to states, and states that wish to keep supervision may do so. A third objection is cost: that more billing practitioners will mean more services. The quality and cost evidence available suggests comparable costs, and many of the bill's provisions eliminate duplicate physician sign-offs rather than add new services. The bill's limit is that federal change alone will not ensure access; as the systematic review shows, organizations must also credential and integrate advanced practice nurses (Koyuncu et al., 2026).

A Christian Worldview and the DNP Role

Scripture describes the body of Christ as many members with different gifts, each needed and none of them free to tell another that it is not needed (English Standard Version Bible, 2001/2016, 1 Corinthians 12:21). Health care works the same way. Physicians and advanced practice nurses bring different training and gifts, and patients are best served when each can contribute fully. For the DNP-prepared nurse, supporting this bill is not about professional status; it is about stewardship of the skills God has given for the care of patients, especially the poor and the rural, whom Scripture repeatedly calls God's people to serve. It also carries responsibility: greater authority calls for humility, collaboration and knowing when to consult, so that the trust the bill extends to advanced practice nurses is honored in every patient encounter.

Conclusion and Advocacy

H.R. 1317 would align federal Medicare and Medicaid rules with the scope of practice states already grant advanced practice registered nurses. Evidence suggests this would improve access, particularly in rural and underserved areas, without harming quality or raising costs, and the bill respects state authority. I support it, and I will ask my representative to cosponsor the bill, sharing a composite case like Mrs. A.'s and the evidence summarized here.

References

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Harrison, J. M., Kranz, A. M., Chen, A. Y., Liu, H. H., Martsolf, G. R., Cohen, C. C., & Dworsky, M. (2023). The impact of nurse practitioner-led primary care on quality and cost for Medicaid-enrolled patients in states with pay parity. Inquiry, 60, Article 469580231167013. https://doi.org/10.1177/00469580231167013

Improving Care and Access to Nurses Act, H.R. 1317, 119th Cong. (2025). https://www.congress.gov/bill/119th-congress/house-bill/1317

Koyuncu, F., Sengul, T., Sarıköse, S., Shoqirat, N., Marsh, Z., Minnick, J., İyigün, E., Kirkland-Kyhn, H., & Singh, C. (2026). Global regulatory and policy pathways for nurse practitioners and their health system contributions: A systematic review. Nursing Outlook, 74(5), Article 102848. https://doi.org/10.1016/j.outlook.2026.102848

Pitts, C. J., & Lindley, L. C. (2026). The impact of nurse practitioner state practice regulation on health and health outcomes: An integrative review. Journal of the American Association of Nurse Practitioners, 38(7), 487-495. https://doi.org/10.1097/JXX.0000000000001264

Waxman, K. T. (2018). Financial and business management for the doctor of nursing practice (2nd ed.). Springer Publishing.