A New Bill Would Have Medicare Pay to Train Advanced Practice Nurses

Medicare already pays hospitals to train new physicians. A bill introduced in the House this fall would have it do the same for nurse practitioners, nurse-midwives, nurse anesthetists and clinical nurse specialists, with at least half of that training happening outside the hospital walls. If you have ever wondered why APRN programs struggle to find clinical placements, this bill is aimed squarely at that problem.

What happened

On September 16, 2026, Rep. Lauren Underwood of Illinois introduced H.R. 10410, the Educating Future Nurses Act, with Rep. Jen Kiggans of Virginia and Rep. Suzanne Bonamici of Oregon as cosponsors. The sponsors include members of both parties. The bill was referred to two House committees: Ways and Means, and Energy and Commerce. Underwood’s office announced it on October 2 and said more than 30 organizations have endorsed it, naming the American Association of Colleges of Nursing and the American Association of Nurse Anesthesiology.

The bill would add a permanent National Graduate Nurse Education Program to Medicare. Hospitals that provide clinical education to advanced practice registered nurse students would be paid a per-student rate, funded from the Medicare trust funds. The bill sets no dollar figure. Instead, the first-year rate would be set from cost data collected during an earlier pilot and then adjusted each year for inflation.

A few requirements stand out in the bill text:

• Each participating hospital needs a written agreement with at least one accredited school of nursing and at least two non-hospital, community-based care settings, such as nursing homes.
• Training must cover primary, preventive, transitional, acute and chronic care. At least half of it must take place in community-based settings, though that rule can be waived for hospitals in rural or medically underserved areas.
• Regional partnerships, called GNE hubs, must coordinate clinical sites and preceptors, reimburse partners promptly and give nursing schools a seat in governance.
• Hospitals must report every year on their students, partners and where graduates go on to practice. Missing or incomplete reports can cut payment by 25 percent.

This idea has been tested. From August 2012 to July 2016, CMS ran the Graduate Nurse Education Demonstration, created by the Affordable Care Act, at five hospitals, including Duke University Hospital, the Hospital of the University of Pennsylvania and Rush University Medical Center. The new bill would turn that time-limited pilot into an ongoing program.

Why it matters at the bedside

The bottleneck in APRN education is rarely the classroom. It is clinical hours. Students need supervised time with real patients, and preceptors (usually practicing APRNs and physicians) often take students on top of a full patient load with little or no compensation. When placements run short, schools cap enrollment, and students sometimes end up hunting for their own preceptors.

Paying hospitals to cover those training costs, and requiring them to coordinate sites and preceptors, is meant to open more slots. The community-based requirement matters too: clinics, nursing homes and other non-hospital settings are where much of the primary and chronic care for older adults happens. In its announcement, Underwood’s office said the goal is to help hospitals take more APRN students, especially in rural and underserved areas. For bedside RNs, more APRNs in the community could mean better follow-up after discharge, the transitional care the bill names explicitly. That is when readmissions and medication problems tend to surface.

What it means for nursing students and the NCLEX

The NCLEX-RN tests RN practice, not APRN practice. But scope-of-practice questions expect you to know who does what. The four APRN roles are the nurse practitioner, the clinical nurse specialist, the certified nurse-midwife and the certified registered nurse anesthetist. Each one requires a graduate degree, national certification and state licensure, and each state’s Nurse Practice Act sets what the role may do there, including prescribing.

The bill’s focus on primary, preventive and chronic care is also a good chance to review levels of prevention, a dependable community health topic. Primary prevention stops disease before it starts (immunizations, health teaching). Secondary prevention catches it early (screenings such as mammograms). Tertiary prevention limits complications once disease exists (cardiac rehab, diabetes self-management).

Finally, the story is a quick civics lesson. Introduction and committee referral are the first steps. The bill would still need committee action, a House vote, passage in the Senate and the President’s signature. Most introduced bills never become law, so treat this as a proposal to watch, not a funding source to plan around.

What to do now

• Considering NP, CRNA, CNM or CNS school? Ask programs how they secure clinical placements and whether students must find their own preceptors.
• Read the bill text on GovInfo. It is short, and seeing the actual language beats secondhand summaries.
• If your unit hosts APRN students, notice how precepting is supported (or not). That is exactly the gap this bill targets.
• Before the NCLEX, make sure you can name the four APRN roles and classify any intervention as primary, secondary or tertiary prevention.