The "Improving Care and Access to Nurses Act" (I CAN Act) seeks to significantly expand the roles and responsibilities of advanced practice registered nurses (APRNs) within the Medicare and Medicaid programs. Its primary goal is to increase patient access to care by removing existing barriers that limit the ability of nurse practitioners, certified registered nurse anesthetists, and certified nurse-midwives to practice to the full extent of their training and state licensure. For nurse practitioners (NPs) , the bill expands their authority to include prescribing exercise for cardiac and pulmonary rehabilitation, documenting eligibility for diabetic shoes, and ordering medical nutrition therapy. NPs would also gain increased roles in hospice care, including certification and billing, and be authorized to oversee care in skilled nursing facilities and for inpatient hospital patients under Medicare and Medicaid. These changes aim to streamline care coordination and reduce administrative burdens. The legislation also addresses certified registered nurse anesthetists (CRNAs) by clarifying that they can be reimbursed for evaluation and management services, including pre-anesthesia assessments. It mandates the revision of regulations to allow CRNAs to order, certify, and refer services as permitted by state law, and removes the requirement for physician supervision of CRNAs. Furthermore, CRNA services would become a Medicaid-required benefit, ensuring broader access to anesthesia care. For certified nurse-midwives (CNMs) , the bill improves access to training in maternity care and allows them to certify and oversee home health services for Medicare beneficiaries. CNMs would also be authorized to order durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), enhancing their ability to provide comprehensive care. Technical changes are also made to their qualifications and conditions for services. Finally, the bill includes provisions that benefit all APRNs, such as allowing them to serve as locum tenens providers, ensuring continuity of care. It also revises the Medicare local coverage determination process to increase transparency and prohibit contractors from imposing practitioner qualification limitations. Most provisions are set to take effect 90 days after enactment, with the Secretary of Health and Human Services authorized to implement them via interim final rule or subregulatory guidance.