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. Since last month’s update, 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 forthcoming Wisconsin Board of Nursing’s (“BON”) implementing regulations. As the effective date inches closer and some in the industry are providing conflicting guidance, we want to ensure you have updated information.

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. These arrangements ensured APNPs’ access to an appropriate provider for as-needed consultations and referrals.

Although the BON has not yet finalized regulations implementing the Act, the Act will replace the APNP designation with the title Advanced Practice Registered Nurse (“APRN”). Wisconsin will continue to recognize the traditional four advanced practice nursing roles: (1) nurse practitioner; (2) certified nurse-midwife (“CNM”); (3) certified registered nurse anesthetist; and (4) clinical nurse specialist.

However, unlike the current APNP licensure requirements, an APRN license will permit the provider to practice without a collaborative agreement if they meet the following two conditions:

  1. 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 was “immediately available for consultation” and accepted responsibility for the APRN’s actions during those hours; and
  2. The APRN must have practiced in the recognized role for at least 24 months.

An APRN is not compliant with the licensure rules if they practice without a collaborative agreement, unless both conditions have been satisfied. Note: different rules appear to apply to CNMs depending upon whether the CNM delivers outside a hospital. We expect the BON to provide additional guidance on this issue soon.

But the Licensure Rules Are Not the End of the Story; Collaborative Arrangements May Still Be Required in Certain Circumstances

As a practical matter, the impact of the Modernization Act may be limited.

Payers. While it would not be a license violation for a qualified APRN to work without any collaborative arrangement after September 1, 2026, such conduct appears to violate the billing requirements of Medicare Part B. Specifically, Medicare will pay for nurse practitioners’ services only if the nurse practitioner “[p]erforms them while working in collaboration with a physician.” Commercial payors may impose similar requirements.

Employers/Medical Staffs. An employer or medical staff may—and many of our clients are continuing to—require that 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. The Act does not define “invasive techniques.”

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 only 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, the revisions appear to apply to all APRNs (except CNMs), including Certified Registered Nurse Anesthetists (“CRNAs”) who have historically been mandatory IPFCF participants. Notably, CNMs appear to be outside the class of APRNs subject to mandatory participation, as would any APRN whose employer or medical staff privileges required collaboration. An important takeaway at this point is that independent IPFCF coverage for APRNs (i.e., coverage that is not provided as a part of entity coverage) is currently only required for APRNs who are practicing independently. If an APRN is practicing under a collaborative relationship (regardless of whether they qualify to practice independently under the Act), they are not practicing independently and will require coverage under an entity policy. As noted above, there may be pending exceptions to the above for CNMs.

Most of this 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 (all) 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 practicing independently (including CRNAs) should assume they are required to obtain independent IPFCF coverage, and APRNs practicing collaboratively (again, including CRNAs) should assume the opposite. However, we will note that these interpretations are subject to change either through a legislative fix or via rulemaking authority or guidance documents issued by the agencies.

Hall Render will continue to monitor communications from the Wisconsin Commissioner of Insurance (where we have been told updates to their FAQs may be published to help clarify this matter) and other regulatory bodies, 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: Employers must carefully review the number and character of clinical hours and months of practice that newly licensed APRNs have completed before any changes to collaboration arrangements are made. Were those hours completed with a physician immediately available and having accepted responsibility for the advanced practice professional’s care?
  • 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 if required.
  • Update Medical Staff Governance and Employment Documents: Bylaws, rules and regulations, policies, privilege cards, application forms, etc., may need to be updated to use the new title; job descriptions and employment contracts may require amending, and collaborative practice agreements/arrangements may need to be amended.

For further information or assistance regarding this topic, please 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.

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