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

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Published January 5, 2023

The Improving Care and Access to Nurses legislation significantly impacts nurses and their patients. Consider seven ways to advocate for improved access to care.
How the Improving Care and Access to Nurses (I CAN) Act Impacts Nurses
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  • The Improving Care and Access to Nurses (I CAN) legislation was introduced into the House of Representatives on September 13, 2022.
  • The I CAN Act removes antiquated federal regulations in the Medicaid and Medicare systems, which then allows APRNs to practice at the top of their license.
  • The I CAN Act improves healthcare options but does not address practice authority, which is regulated by individual states.

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.

What Is the Improving Care and Access to Nurses (I CAN) Act?

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According to the AANP, the act authorizes nurse practitioners to provide care by removing outdated federal barriers.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.

I CAN Support From Nursing Organizations

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.

What the I CAN Act Means for Nurses and Advanced Practice Registered Nurses

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.

Next Steps: 7 Actions Nurses and APRNs Can Take to Improve Healthcare Access

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.

  1. 1

    Advocate for the I CAN Act

    The I CAN legislation is currently under consideration in the House. Nurses and APRNs can advocate for the legislation by calling and writing their state representatives with information on how it can improve access to healthcare for their patients.

  2. 2

    Advocate for Full-Practice Authority

    Not all states have full-practice authority, which allows nurse practitioners to open their own practices. The American Medical Association is also fighting the move toward full-practice authority. It is important for all nurses to work with their local nursing associations to support full-practice authority in their state.

  3. 3

    Open an NP-Led Practice

    APRNs can improve access to healthcare by opening an NP-led practice. Nurses can support NP-led practices through referral and employment within the practice.

  4. 4

    Advocate for Primary Care Reimbursement

    States also control third-party reimbursement through the state insurance department and Medicaid programs. Advocating for the I CAN Act helps break down those barriers. Additionally, states regulate primary care reimbursement in a variety of fash

    For example, Vermont and North Carolina use community health teams and Colorado's Medicaid program uses enhanced payment for preventive services to practitioners who meet certain criteria. Nurses and APRNs can advocate within their state legislature for appropriate primary care reimbursement, which in turn opens access to healthcare practices.

  5. 5

    Work With Telemedicine

    Nurses and nurse practitioners can improve access by working with telemedicine practices that use web-based technologies for patient care. This enhances access in isolated areas and can save time and money for the healthcare practitioner and patient.

  6. 6

    Advocate for Patient Needs in the Community

    All nurses can advocate for the needs of patients and their families in the community by addressing their needs with people in positions of authority. Nurses can use their expertise and experiences to persuade the local and state governments to address issues in the healthcare system.

  7. 7

    Advocate for Policy Changes

    Nurses sometimes feel intimidated by advocating for policy change and may not know how to get involved as a nurse. It is essential that all nurses recognize the knowledge and expertise they carry, which is critical to improving access to healthcare. Consider working with your local and state nurses association to translate your experience and numbers to influence all levels of government.

Sources

AANP applauds U.S. house legislation strengthening patient access to health care. (2022).

https://www.aanp.org/news-feed/aanp-applauds-us-house-legislation-strengthening-patient-access-to-health-care

AMA successfully fights scope of practice expansions that threaten patient safety. (1995-2022). https://www.ama-assn.org/practice-management/scope-practice/ama-successfully-fights-scope-practice-expansions-threaten

Barnes H, et al. (2018). Rural and nonrural primary care physician practices increasingly rely on nurse practitioners. https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.1158

H.R. 8812 - I CAN act. (2022). https://www.congress.gov/bill/117th-congress/house-bill/8812?s=1&r=14

ICAN act increases patient access to high quality healthcare. (2022).

https://www.aana.com/news/press-releases/2022/09/26/ican-act-increases-patient-access-to-high-quality-healthcare

Nursing associations applaud legislation to remove practice barriers. (2022).

https://www.nursingworld.org/news/news-releases/2022-news-releases/nursing-associations-applaud-legislation-to-remove-practice-barriers/

Quality of nurse practitioner practice. (2020).

https://www.aanp.org/advocacy/advocacy-resource/position-statements/quality-of-nurse-practitioner-practice

State and federal efforts to enhance access to basic health care. (2022). https://www.commonwealthfund.org/publications/newsletter-article/state-and-federal-efforts-enhance-access-basic-health-care

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