REMINDER: Wisconsin’s APRN Modernization Act Becomes Effective September 1

Wisconsin joins the growing list of states granting Advanced Practice Registered Nurses (“APRNs”) full practice authority. Passed in early August 2025, the APRN Modernization Act (the “Act”) will take effect on September 1, 2026, and the license of qualified advanced practice nurses will no longer require that they practice in a collaborative arrangement with a physician or dentist. However, questions still remain regarding how this new law will interact with certain government and commercial payor requirements.

Historically, Wisconsin provided for the certification of Advanced Practice Nurse Prescribers (“APNPs”), who were required to enter into documented collaborative arrangements with physicians or dentists, ensuring that the APNP had access to a physician/dentist for consultation and referral as needed. Under the new law, the Board of Nursing (“BON”) will issue a separate license and retitle the role as APRN.

While the BON has not yet released new or revised regulations to address changes triggered by the Act, we do know that there will continue to be four advanced practice nursing roles, including nurse practitioner, certified nurse-midwife (“CNM”), certified registered nurse anesthetist and clinical nurse specialist (each a “Recognized Role”), and that a current national certification in the Recognized Role will still be required. Note, it is anticipated that the regulations will provide that CNMs are fully exempt from state collaboration and Injured Patients and Families Compensation Fund (“IPFCF”) requirements, but must submit to the BON and follow a plan for births outside of a hospital.

Unlike the previous APNP certification, however, an APRN’s license will permit him/her to practice independently, without a collaborative agreement with a physician or dentist, after the following requirements are met:

The APRN has completed at least 3,840 clinical hours of advanced practice registered nursing in their Recognized Role, with a physician or dentist who is “immediately available for consultation” and accepted responsibility for the APRN’s actions during those hours; and
At least 24 months must have elapsed since the APRN began practicing in the Recognized Role.

Until both conditions are met, the APRN’s Wisconsin license will require that they practice under a collaborative agreement. Collaboration may also continue to be required for a licensee practicing in pain management if he/she is not an employee of or holding medical staff privileges at a hospital or hospital clinic.

In addition, APRNs will now also be required to have IPFCF coverage, and therefore, they will have to maintain malpractice insurance coverage at levels not less than those established for participation in the IPFCF.

That said, there may be a disconnect between what Wisconsin law allows in theory and what government payor rules, like Medicare Part B, require in practice. For example, in order to bill Medicare for nurse practitioner services under Part B, the Medicare rules require that an APRN enter into a collaborative agreement or other consultation arrangement with a physician as a condition of obtaining/maintaining employment and/or privileges. 42 CFR 410.75 says the following (emphasis added):

Medicare Part B covers nurse practitioners’ services in all settings in both rural and urban areas, only if the services would be covered if furnished by a physician, and the nurse practitioner:

1. Is legally authorized to perform them in the State in which they are performed;
2. Is not performing services that are otherwise excluded from coverage because of one of the statutory exclusions; and
3. Performs them while working in collaboration with a physician.
  1. Collaboration is a process in which a nurse practitioner works with one or more physicians to deliver health care services within the scope of the practitioner’s expertise, with medical direction and appropriate supervision as provided for in jointly developed guidelines or other mechanisms as provided by the law of the State in which the services are performed.
  2. In the absence of State law governing collaboration, collaboration is a process in which a nurse practitioner has a relationship with one or more physicians to deliver health care services. Such collaboration is to be evidenced by nurse practitioners documenting their scope of practice and indicating the relationships that they have with physicians to deal with issues outside their scope of practice. Nurse practitioners must document this collaborative process with physicians.
  3. The collaborating physician does not need to be present with the nurse practitioner when the services are furnished or to make an independent evaluation of each patient who is seen by the nurse practitioner.

As such, it is not entirely clear whether APRNs practicing without a collaborative arrangement with a physician in Wisconsin will be able to bill Medicare Part B for their services. The analysis would seem to depend on whether CMS considers Wisconsin’s new law to constitute sufficient supervision “as provided by the law in the State in which the services are performed,” or whether CMS considers this new law to constitute an “absence” of a law governing collaboration. Other commercial payors may have similar requirements.

We’ll note that while the Act permits a broader scope of practice for APRNs, it does not require that the scope be increased. An employer or medical staff may continue to require that all APRNs practice under a collaborative practice arrangement with a physician as a condition of employment or to be granted medical staff privileges.

Since there continue to be open questions about this Act, including how it interacts with payor requirements and the Conditions of Participation, and what the BON’s regulations will entail, we will continue to monitor developments and update readers as we receive more information. In the event that CMS and/or the BON fail to clarify the expectations prior to September 1, revisions to collaboration arrangements, rather than termination of the arrangements, may be prudent.

Practical Takeaways

Review Payor Requirements Before You Make Staffing Changes: Payor requirements likely trump Wisconsin’s scope of practice rules. Therefore, review payor guidance (including Medicare and Medicaid) to ascertain when physicians are required to provide or supervise services, and when collaboration is required.
Review Clinical Hours: Employers must carefully review the number of clinical hours and months of practice that newly-licensed APRNs have completed before any changes to collaboration agreements are made.
Monitor Rulemaking: Monitor rulemaking from CMS and the BON, which may include continuing education or practice requirements.
Assess Insurance: Ensure that APRNs have appropriate malpractice insurance coverage and are participating in the IPFCF as required.
Update Medical Staff Governance and Employment Documents: Bylaws, Rules & Regulations, policies, privilege cards, application forms, etc., may need to be updated to use the new title and address changes to the scope of practice for APRNs; job descriptions and employment contracts may require amending; and collaborative practice agreements may need to be amended.

For further information or assistance regarding this topic, please contact:

Robin Sheridan at (414) 721-0469 or rsheridan@hallrender.com;
Lori Wink at (414) 721-0456 or lwink@hallrender.com
Ben Lockwood at (414) 721-0484 or blockwood@hallrender.com; or
Your primary Hall Render contact.

Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot—outside of an attorney-client relationship—answer specific questions that would be legal advice.