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

The Improving Care and Access to Nurses (I CAN) Act strips out old federal rules in Medicare and Medicaid that keep advanced practice registered nurses (APRNs) from practicing to the full extent of their license. It expands what you can do for those patients. It does not touch full-practice authority, which each state controls on its own.

APRNs carried enormous patient loads through the pandemic across every kind of setting, and they could have done more if federal rules had let them. APRN care is tied to higher patient satisfaction, better communication, and fewer emergency room visits. Patient outcomes between NPs and physicians are comparable, and in some cases patients do better with an NP.

The bill was first introduced in 2022 and reintroduced in the 119th Congress on February 14, 2025, as H.R. 1317 in the House and S. 575 in the Senate. House sponsors include Reps. Dave Joyce (R-OH), Suzanne Bonamici (D-OR), Lauren Underwood (D-IL), and Jen Kiggans (R-VA). The Senate version is sponsored by Sens. Jeff Merkley (D-OR) and Cynthia Lummis (R-WY).

What the I CAN Act Does

The legislation removes barriers to nurse practitioner practice inside Medicare and Medicaid, expanding access to services from the more than 200,000 APRNs currently practicing.

Around 40% of Medicare beneficiaries get their care from nurse practitioners. In 2016, NPs accounted for 25% of providers in rural areas, and 87% of NPs were certified in primary care. These are the patients and communities the bill reaches.

The act lets NPs refer patients for medical and nutritional therapy, certify and recertify terminal illness for hospice eligibility, and order and supervise cardiac and pulmonary rehabilitation. Right now, federal rules block NPs from providing those services to Medicare and Medicaid patients even when their training fully qualifies them. The bill updates both programs to match how care is actually delivered.

Who Supports It

The American Nurses Association (ANA), the American Association of Nurse Practitioners (AANP), the American College of Nurse-Midwives, and the American Association of Nurse Anesthesiology all back the I CAN Act. They call it a necessary step toward recognizing what APRNs already do in the healthcare system.

Past AANP President April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, summed up the case: the act would "improve our healthcare system, retire barriers to practice, and enable patients to receive timely access to healthcare from their chosen healthcare provider."

What It Means for You

During the pandemic, federal and state waivers let APRNs practice at the top of their license so COVID-19 and non-COVID patients could still get high-quality care. The I CAN Act would make that kind of access permanent under Medicare and Medicaid, letting advanced practice nurses care for patients to the full extent of their education with less interference.

The bill does not grant full-practice authority. That stays with the states. The AANP tracks the state practice environment for APRNs across the U.S. and its territories, and most states plus the District of Columbia now grant full-practice authority, with the current count and map kept on the AANP site. In those states, NPs can evaluate and diagnose, order and interpret tests, manage treatment, and prescribe medications and controlled substances.

Certified registered nurse anesthetists (CRNAs) are a clear example of why this matters. CRNAs are often the predominant anesthesia provider in rural and underserved hospitals, and the I CAN Act improves their Medicare and Medicaid reimbursement for evaluation and management services, which protects access in the places that can least afford to lose it.

What You Can Do to Improve Access

Nurses are usually more reachable than physicians and see firsthand how disparities hit the communities they serve. That makes you a real asset in opening up healthcare access. Here is where to put that.

Advocate for the I CAN Act. Call and write your representatives with concrete examples of how the bill would improve access for your patients.

Advocate for full-practice authority. Not every state has it, and the American Medical Association actively fights its expansion. Work with your state nursing association to push for it where you practice.

Open or support an NP-led practice. APRNs can open their own practices in full-practice states, and other nurses can support them through referrals and employment.

Advocate for primary care reimbursement. States control third-party reimbursement through their insurance departments and Medicaid programs. Vermont and North Carolina use community health teams; Colorado's Medicaid program pays more for preventive services that meet certain criteria. Push your legislature for reimbursement that actually opens access.

Use telemedicine. Web-based care reaches isolated areas and saves time and money for both you and the patient.

Speak up in your community. Bring your expertise to the people who set policy locally. Your experience is the evidence they do not otherwise have.

Get involved in policy. Plenty of nurses feel out of their depth here, but your clinical knowledge is exactly what policymakers lack. Your state nurses association can help you turn that experience into influence at every level of government.