Last year, Hall Render introduced you to the APRN Modernization Act (“the Act”) after Wisconsin passed it into law in early August 2025. The Act, which takes effect on September 1, 2026, modifies licensure requirements so that qualified advanced practice nurses may practice without a collaborative arrangement with a physician or dentist. As September 1 approaches, questions remain regarding how the Act will interact with payor requirements, including the Medicare Conditions of Participation, the Wisconsin Injured Patients and Families Compensation Fund (“IPFCF”) and the recently released Wisconsin Board of Nursing’s (“BON”) implementing regulations.
A Brief Review
As a condition of licensure, Wisconsin historically required Advanced Practice Nurse Prescribers (“APNPs”) to enter into documented collaborative arrangements with physicians or dentists. The Act will replace the APNP designation with the title Advanced Practice Registered Nurse (“APRN”) but will continue to recognize the traditional four advanced practice nursing roles: (1) nurse practitioner (“NP”); (2) certified nurse-midwife (“CNM”); (3) certified registered nurse anesthetist (“CRNA”); and (4) clinical nurse specialist (“CNS”).
Under the Act, CNMs do not require collaboration. However, NPs, CRNAs and CNSs will be permitted to practice without collaboration if they meet certain conditions, including all of the following:
- Completion of 3,840 hours of professional nursing in a clinical setting, provided that at least 24 months have elapsed since the nurse first began completing the clinical hours required by a qualifying nursing program;
- Completion of at least 3,840 clinical hours of advanced practice registered nursing in a recognized role while working with a licensed physician or dentist who was immediately available for consultation and accepted responsibility for the APRN’s actions during those hours, provided that at least 24 months have elapsed since the nurse first began practicing advanced practice registered nursing in that recognized role.
- Submission of evidence of satisfying the requirement above on a form provided by the BON. It must be completed and signed by a medical director in charge of the nurse’s employment, the dean in charge of clinical hours at a qualifying school of nursing or an authorized individual in charge of the clinical setting who can verify the nurse’s clinical hours.
But the Licensure Rules Are Not the End of the Story…
As a practical matter, the impact of the Act may be limited.
Payers. It would not be a license violation for a qualified APRN to work without a collaborative arrangement after September 1, 2026. However, Medicare will pay for NP and CNS services only if the practitioner “[p]erforms them while working in collaboration with a physician.” Commercial payors may impose similar requirements. Medicare does not require that CNMs or CRNAs collaborate for payment under Part B, but instead, defers to State law.
Employers/Medical Staffs. An employer or medical staff may—and many of our clients are continuing to—require that all APRNs practice with a collaborative practice arrangement with a physician or dentist as a condition of employment and/or for medical staff privileges.
Pain Management. The Act appears to require collaboration arrangements for all APRNs (irrespective of tenure) practicing in pain management who are not employees of or holding medical staff privileges at a hospital or hospital clinic. Specifically, the Act requires APRNs “treating pain . . . [using] invasive techniques” to work in a collaborative relationship with a physician.
Participation in the Injured Patients and Families Compensation Fund
Significant questions remain with respect to the Act’s impact on IPFCF coverage. The Act amends Wis. Stat. § 655.001(1g) (“the Statute”) to include certain advanced practice registered nurses as mandatory participants in the IPFCF. Changes to the Statute published July 1, 2026, provide that participation in the IPFCF is required from those APRNs who (1) qualify to practice independently in their recognized role; and (2) practice outside of a collaborative relationship with a physician or dentist. Interestingly, CRNAs with collaboration arrangements, who have historically been mandatory IPFCF participants, are currently outside the class of APRNs subject to mandatory participation. IPFCF’s position on CNM participation is unclear.
Much of the confusion arises out of the different ways “APRN” is defined across statutory chapters. The chapter detailing licensure requirements (Ch. 441) defines APRNs broadly to include all APRNs, whether or not practicing under a collaborative arrangement with a physician. However, the chapter for IPFCF requirements (Ch. 655) defines “APRN” more narrowly as those APRNs who have qualified to practice independently. The confusion also comes about due to a change in the IPFCF coverage law that originally required both physicians and CRNAs to obtain coverage but was subsequently revised by the Act to require physicians and independent APRNs to obtain coverage. Since the two statutes refer to each other via cross-references, it becomes a matter of delicate statutory interpretation to parse the various meanings, and we understand that the literal interpretation is not necessarily how the drafters intended the statutes to be read. Thus, for the time being, APRNs (other than CNMs, perhaps) practicing independently should assume they are required to obtain IPFCF coverage, and APRNs practicing collaboratively (including CRNAs) should assume the opposite. Note: the type of coverage required for collaborating APRNs (i.e., whether each must be individually named under an entity policy) is also unclear. We note that these interpretations are subject to change either through a legislative fix or via rulemaking authority or guidance documents issued by the agencies and encourage all clients to work closely with their insurance brokers/carriers with respect to these issues.
Hall Render will continue to monitor communications from the various agencies, and we will update readers as we receive more information.
Practical Takeaways
- Before You Make Staffing Changes: Review payor guidance (including Medicare and Medicaid) to ascertain when physicians are required to provide or supervise services and when collaboration is required as a condition of payment.
- Review Clinical Hours: “Independent Practice Eligible” will be noted on an APRN’s credential if the Department of Safety and Professional Services (“DSPS”) has determined that they met the training requirements. Without such a designation, collaboration is required for NPs, CRNAs and CNSs.
- Monitor Rulemaking: Monitor rulemaking from CMS and DSPS.
- Assess Insurance: Ensure that APRNs have appropriate malpractice insurance coverage and are participating in the IPFCF if required.
- Update Medical Staff Governance and Employment Documents: Medical Staff bylaws, rules and regulations, policies, privilege cards, application forms, etc. may need to be revised to use the new title and/or where independent practice is permitted; job descriptions, employment contracts and/or collaborative practice agreements may need to be reviewed.
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.
Thank you to Summer Associates Lauren Frazier and Julia Hallauer for their assistance in the preparation of this article.
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.
