[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1317 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 1317
To amend titles XVIII and XIX of the Social Security Act to increase
access to services provided by advanced practice registered nurses
under the Medicare and Medicaid programs, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 13, 2025
Mr. Joyce of Ohio (for himself, Ms. Bonamici, Mrs. Kiggans of Virginia,
Ms. Underwood, and Mr. Rogers of Alabama) introduced the following
bill; which was referred to the Committee on Energy and Commerce, and
in addition to the Committee on Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To amend titles XVIII and XIX of the Social Security Act to increase
access to services provided by advanced practice registered nurses
under the Medicare and Medicaid programs, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

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(a) Short Title.--This Act may be cited as the ``Improving Care and
Access to Nurses Act'' or the ``I CAN Act''.
(b) Table of Contents.--The table of contents of this Act is as
follows:

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pulmonary rehabilitation programs under
Medicare program.

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TITLE I

-REMOVAL OF BARRIERS TO PRACTICE ON NURSE PRACTITIONERS

satisfy Medicare documentation requirement
for coverage of certain shoes for
individuals with diabetes.

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nursing facilities; authorizing Medicare
and Medicaid inpatient hospital patients to
be under the care of a nurse practitioner.

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be reimbursed by Medicare for evaluation
and management services.

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TITLE II

-REMOVAL OF BARRIERS TO PRACTICE ON CERTIFIED REGISTERED NURSE

ordered and referred by certified
registered nurse anesthetists.

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TITLE III

-REMOVAL OF BARRIERS TO PRACTICE ON CERTIFIED NURSE-MIDWIVES

respect to the services of certified nurse-
midwives.
REGISTERED NURSES

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TITLE IV

-IMPROVING FEDERAL HEALTH PROGRAMS FOR ALL ADVANCED PRACTICE

PULMONARY REHABILITATION PROGRAMS UNDER MEDICARE PROGRAM.
(a) Cardiac Rehabilitation Programs.--Section 1861(eee) of the
Social Security Act (42 U.S.C. 1395x(eee)) is amended--
(1) in paragraph (2)--
(A) in subparagraph (A)(i), by striking ``a
physician's office'' and inserting ``the office
setting''; and
(B) in subparagraph (C), by inserting after
``physician'' the following: ``(as defined in
subsection (r)(1)) or a physician assistant, nurse
practitioner, or clinical nurse specialist (as those
terms are defined in subsection (aa)(5))'';
(2) in paragraph (3)(A), by striking ``physician-prescribed
exercise'' and inserting ``exercise prescribed by a physician
(as defined in subsection (r)(1)) or a physician assistant,
nurse practitioner, or clinical nurse specialist (as those
terms are defined in subsection (aa)(5))''; and
(3) in paragraph (5), by inserting after ``physician'' the
following: ``(as defined in subsection (r)(1)) or a physician
assistant, nurse practitioner, or clinical nurse specialist (as
those terms are defined in subsection (aa)(5))''.
(b) Pulmonary Rehabilitation Programs.--Section 1861(fff) of the
Social Security Act (42 U.S.C. 1395x(fff)) is amended--
(1) in paragraph (2)(A), by striking ``physician-prescribed
exercise'' and inserting ``exercise prescribed by a physician
(as defined in subsection (r)(1)) or a physician assistant,
nurse practitioner, or clinical nurse specialist (as those
terms are defined in subsection (aa)(5))''; and
(2) in paragraph (3), by inserting after ``physician'' the
following: ``(as defined in subsection (r)(1)) or a physician
assistant, nurse practitioner, or clinical nurse specialist (as
those terms are defined in subsection (aa)(5))''.

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SATISFY MEDICARE DOCUMENTATION REQUIREMENT FOR COVERAGE
OF CERTAIN SHOES FOR INDIVIDUALS WITH DIABETES.
Section 1861(s)(12) of the Social Security Act (42 U.S.C.
1395x(s)(12)) is amended--
(1) in subparagraph (A), by inserting ``, nurse
practitioner, or physician assistant'' after ``physician''; and
(2) in subparagraph (C), by inserting ``, nurse
practitioner, or physician assistant'' after each occurrence of
``physician''.

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MEDICARE SHARED SAVINGS PROGRAM.
Section 1899(c)(1) of the Social Security Act (42 U.S.C.
1395jjj(c)(1)) is amended--
(1) in subparagraph (A), by striking ``and'' at the end;
(2) in subparagraph (B), by striking the period at the end
and inserting ``; and''; and
(3) by adding at the end the following new subparagraph:
``(C) in the case of performance years beginning on
or after January 1, 2026, primary care services
provided under this title by an ACO professional
described in subsection (h)(1)(B).''.

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SERVICE MEDICARE PROGRAM.
Section 1861(vv)(1) of the Social Security Act (42 U.S.C.
1395x(vv)(1)) is amended by inserting `` or a nurse practitioner, a
clinical nurse specialist, or a physician assistant (as such terms are
defined in subsection (aa)(5))'' before the period at the end.

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(a) Allowing Applicable Providers To Establish Home Infusion
Therapy Plans.--Section 1861(iii)(1)(B) of the Social Security Act (42
U.S.C. 1395x(iii)(1)(B)) is amended--
(1) by striking ``a physician (as defined in subsection
(r)(1))'' and inserting ``an applicable provider (as defined in
paragraph (3)(A))''; and
(2) by striking ``a physician (as so defined)'' and
inserting ``an applicable provider (as so defined)''.
(b) Conforming Amendment.--Section 1834(u)(6) of the Social
Security Act (42 U.S.C. 1395m(u)(6)) is amended by striking
``physician'' and inserting ``applicable provider (as defined in
section 1861(iii)(3)(A))''.

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(a) In General.--Section 1814(a)(7)(A) of the Social Security Act
(42 U.S.C. 1395f(a)(7)(A)) is amended--
(1) in clause (i)--
(A) in subclause (I), by striking ``a nurse
practitioner or'';
(B) in subclause (II), by inserting ``or nurse
practitioner'' after ``physician''; and
(C) in the flush matter following subclause (II),
by inserting ``, nurse practitioner's,'' after
``physician's''; and
(2) in clause (ii), by striking ``or physician'' and
inserting ``, physician, or nurse practitioner''.
(b) Hospice Care Definition.--Section 1861(dd)(1)(C) of the Social
Security Act (42 U.S.C. 1395x(dd)(1)(C)) is amended by inserting ``or
nurse practitioner'' after ``physician''.
(c) Nurse Practitioner Billing.--Not later than 90 days after the
date of the enactment of this Act, the Secretary of Health and Human
Services shall revise section 418.304 of title 42, Code of Federal
Regulations, to allow nurse practitioners to bill for services not
described in paragraph (a) of such section in the same manner as
physicians may bill for such services in accordance with paragraph (b)
of such section. Such revision shall provide that such services
furnished by a nurse practitioner shall be payable at the percent of
the physician fee schedule specified in section 1833(a)(1)(O) of the
Social Security Act (42 U.S.C. 1395l(a)(1)(O)).

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NURSING FACILITIES; AUTHORIZING MEDICARE AND MEDICAID
INPATIENT HOSPITAL PATIENTS TO BE UNDER THE CARE OF A
NURSE PRACTITIONER.
(a) Medicare.--
(1) Certification of post-hospital extended care
services.--Section 1814(a)(2) of the Social Security Act (42
U.S.C. 1395f(a)(2)) is amended, in the matter preceding
subparagraph (A), by striking ``, or a nurse practitioner,''
and inserting ``or a nurse practitioner (in accordance with
State law), or''.
(2) Certification authority for nurse practitioners.--
Section 1814(a)(3) of the Social Security Act (42 U.S.C.
1395f(a)(3)) is amended by inserting ``or nurse practitioner''
after ``physician''.
(3) Supervision requirement in skilled nursing facility
services and resident's rights.--Section 1819 of the Social
Security Act (42 U.S.C. 1395i-3(b)(6)) is amended--
(A) in subsection (b)--
(i) in paragraph (2)(B), by inserting ``or
nurse practitioner'' after ``attending
physician''; and
(ii) in paragraph (6)--
(I) in the heading, by striking
``Physician supervision'' and inserting
``Supervision''; and
(II) in subparagraph (A), by
inserting ``or a nurse practitioner, in
accordance with State law'' after
``physician''; and
(B) in subsection (c)--
(i) in subparagraph (1)(A)(i), by inserting
``or nurse practitioner'' after ``attending
physician'';
(ii) in the flush matter at the end of
subparagraph (2)(A), by inserting ``or nurse
practitioner'' after ``physician'' in each
occurrence; and
(iii) in subparagraph (3)(A), by inserting
``or nurse practitioner'' after ``physician''.
(4) Administration of part b.--Section 1842(b)(2)(C) of the
Social Security Act (42 U.S.C. 1395u(b)(2)(C)) is amended, in
the second sentence--
(A) by inserting ``or a nurse practitioner'' after
``a physician''; and
(B) by striking ``or a nurse practitioner working
in collaboration with that physician, or both''.
(5) Provision of medical and other health services.--
Section 1861(s)(2)(K)(ii) of the Social Security Act (42 U.S.C.
1395x(s)(2)(K)(ii)) is amended by striking ``or clinical nurse
specialist (as defined in subsection (aa)(5)) working in
collaboration (as defined in subsection (aa)(6)) with a
physician (as defined in subsection (r)(1))'' and inserting
``(as defined in subsection (aa)(5)(A)), or by a clinical nurse
specialist (as defined in subsection (aa)(5)(B)) working in
collaboration with a physician (as defined in subsection
(r)(1)),''.
(6) Privileges for nurse practitioners.--Section 1861 of
the Social Security Act (42 U.S.C. 1395x) is amended--
(A) in subsection (e)(4), by inserting ``(or nurse
practitioner, in accordance with State law)'' after
``physician'';
(B) in subsection (f)(1), by inserting ``or nurse
practitioner'' after ``physician''; and
(C) in each of subparagraphs (B) and (F) of
subsection (ee)(2), by inserting ``or nurse
practitioner'' after ``physician''.
(b) Medicaid.--
(1) Certification authority for nurse practitioners.--
Section 1902(a)(44) of the Social Security Act (42 U.S.C.
1396a(a)(44)) is amended to read as follows:
``(44) in each case for which payment for inpatient
hospital services, skilled nursing facility services, services
in an intermediate care facility described in section 1905(d),
or inpatient mental hospital services is made under the State
plan--
``(A) a physician or nurse practitioner (or, in the
case of skilled nursing facility services or
intermediate care facility services, a physician or
nurse practitioner, or a clinical nurse specialist who
is not an employee of the facility but is working in
collaboration with a physician) certifies at the time
of admission, or, if later, the time the individual
applies for medical assistance under the State plan
(and a physician or nurse practitioner, or a physician
assistant under the supervision of a physician, or, in
the case of skilled nursing facility services or
intermediate care facility services, a physician or
nurse practitioner, or a clinical nurse specialist who
is not an employee of the facility but is working in
collaboration with a physician, recertifies, where such
services are furnished over a period of time, in such
cases, at least as often as required under section
1903(g)(6) (or, in the case of services that are
services provided in an intermediate care facility,
every year), and accompanied by such supporting
material, appropriate to the case involved, as may be
provided in regulations of the Secretary), that such
services are or were required to be given on an
inpatient basis because the individual needs or needed
such services, and
``(B) such services were furnished under a plan
established and periodically reviewed and evaluated by
a physician or nurse practitioner, or, in the case of
skilled nursing facility services or intermediate care
facility services, by a physician or nurse
practitioner, or a clinical nurse specialist who is not
an employee of the facility but is working in
collaboration with a physician;''.
(2) Nursing facility services supervision and clinical
records.--Section 1919(b)(6)(A) of the Social Security Act (42
U.S.C. 1396r(b)(6)(A)) is amended to read as follows:
``(A) require that the health care of every
resident be provided under the supervision of a
physician or nurse practitioner (or, at the option of a
State, under the supervision of a clinical nurse
specialist or physician assistant who is not an
employee of the facility but who is working in
collaboration with a physician);''.

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Section 1905(a)(9) of the Social Security Act (42 U.S.C.
1396d(a)(9)) is amended by adding ``or nurse practitioner'' after
``physician'' in both places that it appears.
ANESTHETISTS

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BE REIMBURSED BY MEDICARE FOR EVALUATION AND MANAGEMENT
SERVICES.
Section 1861(bb)(1) of the Social Security Act (42 U.S.C.
1395x(bb)(1)) is amended by inserting ``, including pre-anesthesia
evaluation and management services,'' after ``and related care''.

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ORDERED AND REFERRED BY CERTIFIED REGISTERED NURSE
ANESTHETISTS.
Not later than 3 months after the date of enactment of this Act,
the Secretary of Health and Human Services shall revise section 410.69
of title 42, Code of Federal Regulations, to clarify that, for purposes
of payment under part B of title XVIII of the Social Security Act--
(1) certified registered nurse anesthetists are authorized
to order, certify, and refer services to the extent allowed
under the law of the State in which the services are furnished;
and
(2) payment shall be made under such part for such services
so ordered, certified, or referred by certified registered
nurse anesthetists.

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ANESTHETISTS.
Section 1848(a)(6) of the Social Security Act (42 U.S.C. 1395w-
4(a)(6)) is amended, in the matter preceding subparagraph (A), by
inserting ``or student registered nurse anesthetists'' after
``physician residents''.

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REGISTERED NURSE ANESTHETISTS.
Section 1861(bb)(2) of the Social Security Act (42 U.S.C.
1395x(bb)(2)) is amended--
(1) in the second sentence, by inserting ``, but may not
require that certified registered nurse anesthetists provide
services under the supervision of a physician'' after
``certification of nurse anesthetists''; and
(2) in the third sentence, by inserting ``under the
supervision of an anesthesiologist'' after ``an
anesthesiologist assistant''.

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(a) In General.--Section 1905(a)(5) of the Social Security Act (42
U.S.C. 1396d(a)(5)) is amended--
(1) by striking ``and (B)'' and inserting ``(B)''; and
(2) by inserting before the semicolon at the end the
following: ``, and (C) services furnished by a certified
registered nurse anesthetist (as defined in section
1861(bb)(2)), which such certified registered nurse anesthetist
is authorized to perform under State law (or the State
regulatory mechanism as provided by State law)''.
(b) Payment.--Section 1902(a) of the Social Security Act (42 U.S.C.
1396d(a)) is amended--
(1) in paragraph (86), by striking ``and'' at the end;
(2) in paragraph (87), by striking the period and inserting
``; and''; and
(3) by inserting after paragraph (87) the following new
paragraph:
``(88) provide for payment for the services of a certified
registered nurse anesthetist (as defined in section
1861(bb)(1)) in amounts no lower than the amounts, using the
same methodology, used for payment for amounts under section
1833(a)(1)(H).''.

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(a) Medicare Payments for Supervision by Certified Nurse-
Midwives.--Paragraph (1) of section 1861(gg) of the Social Security Act
(42 U.S.C. 1395x(gg)) is amended to read as follows:
``(1) The term `certified nurse-midwife services' means--
``(A) such services furnished by a certified nurse-
midwife (as defined in paragraph (2)); and
``(B) such services (and such supplies and services
furnished as an incident to the nurse-midwife's
service) which--
``(i) the certified nurse-midwife is
legally authorized to perform under State law
(or the State regulatory mechanism provided by
State law) as would otherwise be covered if
furnished by a physician;
``(ii) are furnished under the supervision
of a certified-nurse midwife by an intern or
resident-in-training (as described in
subsection (b)(6));
``(iii) would otherwise be described in
subparagraph (A) if furnished by a certified
nurse-midwife; and
``(iv) would otherwise be covered if
furnished under the supervision of a
physician.''.
(b) Clarifying Permissibility of Using Certain Grants for Clinical
Training by Certified Nurse-Midwives.--Section 811(a)(1) of the Public
Health Service Act (42 U.S.C. 296j(a)(1)) is amended by inserting ``,
including clinical training,'' after ``projects''.

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PROVIDED BY CERTIFIED NURSE-MIDWIVES.
(a) In General.--Section 1835(a) of the Social Security Act (42
U.S.C. 1395n(a)) is amended--
(1) in paragraph (2)--
(A) in the matter preceding subparagraph (A), by
inserting ``or a certified nurse-midwife (as defined in
section 1861(gg)),'' after ``or a physician assistant
(as defined in section 1861(aa)(5)) who is working in
accordance with State law,''; and
(B) in subparagraph (A)--
(i) in each of clauses (ii) and (iii), by
striking ``or a physician assistant (as the
case may be)'' and inserting ``a physician
assistant, or a certified nurse-midwife (as the
case may be)''; and
(ii) in clause (iv), by--
(I) inserting ``or by a certified
nurse-midwife (as defined in section
1861(gg))'' after ``(but in no case
later than the date that is 6 months
after the date of the enactment of the
CARES Act)''; and
(II) by striking ``(as defined in
section 1861(gg))''; and
(2) in the matter following paragraph (2), by striking ``or
physician assistant (as the case may be)'' and inserting
``physician assistant, or certified nurse-midwife (as the case
may be)'' each place it appears.
(b) Conforming Amendments.--Section 1895 of the Social Security Act
(42 U.S.C. 1395(fff)) is amended--
(1) in subsection (c)(1), by inserting ``the certified
nurse-midwife (as defined in section 1861(gg)),'' after
``clinical nurse specialist (as those terms are defined in
section 1861(aa)(5)),''; and
(2) in subsection (e)(1)(A), by striking ``a physician a
nurse practitioner or clinical nurse specialist,'' and
inserting ``a physician, a nurse practitioner, a clinical nurse
specialist, a certified nurse-midwife,''.

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Section 1834(a) of the Social Security Act (42 U.S.C. 1395m(a)) is
amended--
(1) in paragraph (1)(E)(ii) by striking ``or a clinical
nurse specialist (as those terms are defined in section
1861(aa)(5))'' and inserting ``, a clinical nurse specialist
(as those terms are defined in section 1861(aa)(5)), or a
certified nurse-midwife (as defined in section 1861(gg))''; and
(2) in paragraph (11)(B)(ii)--
(A) by striking ``or a clinical nurse specialist
(as those terms are defined in section 1861(aa)(5))''
and inserting ``a clinical nurse specialist (as those
terms are defined in section 1861(aa)(5)), or a
certified nurse-midwife (as defined in section
1861(gg))''; and
(B) by striking ``or specialist'' and inserting
``specialist, or nurse-midwife''.

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RESPECT TO THE SERVICES OF CERTIFIED NURSE-MIDWIVES.
Section 1861(gg)(2) of the Social Security Act (42 U.S.C.
1395x(gg)(2)) is amended by striking ``, or has been certified by an
organization recognized by the Secretary'' and inserting ``and has been
certified by the American Midwifery Certification Board (or a successor
organization)''.
REGISTERED NURSES

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MEDICARE PROGRAM.
(a) In General.--Section 1862(l)(5) of the Social Security Act (42
U.S.C. 1395y(l)(5)) is amended--
(1) in subparagraph (D), by adding at the end the following
new clauses:
``(vi) Identification of any medical or
scientific experts whose advice was obtained by
such contractor during the development of such
determination, whether or not such contractor
relied on such advice in developing such
determination.
``(vii) A hyperlink to any written
communication between such contractor and
another entity that such contractor relied on
when developing such determination.
``(viii) A hyperlink to any rule,
guideline, protocol, or other criterion that
such contractor relied on when developing such
determination.''; and
(2) by adding at the end the following new subparagraphs:
``(E) Prohibition on imposition of practitioner
qualifications.--The Secretary shall prohibit a
Medicare administrative contractor that develops a
local coverage determination from imposing such
determination on any coverage limitation with respect
to the qualifications of a physician (as defined in
section 1861(r)) or a practitioner described in section
1842(b)(18)(C) who may furnish the item or service that
is the subject of such determination.
``(F) Civil monetary penalty.--A Medicare
administrative contractor that develops a local
coverage determination that fails to make information
described in subparagraph (D) available as required by
the Secretary under such subparagraph or comply with
the prohibition under subparagraph (E) is subject to a
civil monetary penalty of not more than $10,000 for
each such failure. The provisions of section 1128A
(other than subsections (a) and (b)) shall apply to a
civil money penalty under the previous sentence in the
same manner as such provisions apply to a penalty or
proceeding under section 1128A(a).''.
(b) Timing of Review.--Section 1869(f)(2) of the Social Security
Act (42 U.S.C. 1395ff(f)(2)) is amended by adding at the end the
following new subparagraph:
``(D) Timing of review.--An aggrieved party may
file a complaint described in subparagraph (A) with
respect to a local coverage determination on or after
the date that such determination is posted, in
accordance with section 1862(l)(5)(D), on the Internet
website of the Medicare administrative contractor
making such determination, whether or not such
determination has taken effect.''.
(c) Effective Date.--The amendments made by this section shall
apply to local coverage determinations made available on the internet
website of a Medicare administrative contractor and on the Medicare
internet website on or after the date of the enactment of this Act.

3b9eb45ac0a4131d6855a699029b4cdfed66d14d01d204caf745de58f0dda146

Section 1842(b)(6) of the Social Security Act (42 U.S.C.
1395u(b)(6)) is amended, in the first sentence--
(1) by striking ``and (J)'' and inserting ``(J)''; and
(2) by inserting before the period at the end the
following: ``, and (K) in the case of services furnished by a
certified registered nurse anesthetist (as defined in section
1861(bb)(2)), nurse practitioner, or clinical nurse specialist
(as defined in section 1861(aa)(5)), or a certified nurse
midwife (as defined in section 1861(gg)(2)), subparagraph (D)
of this sentence shall apply to such services and such
anesthetist, practitioner, specialist, or nurse-midwife in the
same manner as such subparagraph applies to physicians'
services furnished by physicians''.

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The provisions of, including the amendments made by, this Act
(other than sections 103 and 401) shall apply with respect to items and
services furnished on or after the date that is 90 days after the date
of the enactment of this Act. Notwithstanding any other provision of
law, the Secretary of Health and Human Services shall implement such
provisions, including such amendments, through interim final rule or
subregulatory guidance if the Secretary determines such implementation
to be necessary for purposes of complying with the preceding sentence
or with any other effective date provided in this Act.
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I CAN Act — HR. 1317

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