April 2026 Policy Update
Key developments this month
- The comment period is open for the CMS FY 2027 inpatient psychiatric facility proposed rule.
- FY 2027 budget proposals include cuts to nursing-related programs and a major restructuring for HHS.
- Federal policy developments for psychedelics and cannabis as emerging treatments.
- New Jersey enacted Full Practice Authority for eligible advanced practice nurses, including PMH-APRNs.
CMS FY 2027 inpatient psychiatric facility proposed rule
- Published and open for comment! CMS issued the rule on April 2, 2026. Currently published in the Federal Register, the comment period is open through June 1, 2026. The rule includes a 2.3% payment-rate update, an estimated 2.1% overall payment increase, a 20% cap on outlier payments, a standardized IPF patient assessment instrument, and removal of two IPF Quality Reporting Program measures.
FY 2027 federal budget proposal
- The President’s 2027 Fiscal Year Budget proposal would cut funding for the National Institute of Nursing Research (NINR), but preserve it as an independent institute within NIH. The budget also proposes the elimination of most of Title VIII Nursing Workforce Development Programs. The Nursing Community Coalition, of which APNA is a member, has provided this chart of nursing-related funding and issued a statement.
- HHS also released its FY 2027 Budget in Brief, which includes a major restructuring through the creation of an Administration for a Healthy America (AHA) that combines select programs from OASH, HRSA, SAMHSA, and parts of CDC.
Private payer policy
Optum expands policy to allow PMHNPs to administer transcranial magnetic stimulation (TMS)
- Optum (United Behavioral Health) updated its coverage policy to allow psychiatric-mental health nurse practitioners (PMHNPs) to administer transcranial magnetic stimulation (TMS) for patients with treatment-resistant depression.
What to watch
DEA telehealth prescribing flexibilities
- The temporary federal flexibilities extension remain in effect through December 31, 2026, which means that Schedule II–V prescribing via telehealth may continue without an initial in-person visit. The DEA’s proposed permanent telemedicine prescribing framework, which was published in the Federal Register in January 2025, is still pending but expected to be finalized before the end of the year.
Psychedelic policy: federal action and research expansion
- The new “Accelerating Medical Treatments for Serious Mental Illness” executive order directs FDA and DEA to accelerate research and explore access pathways for the psychedelics psilocybin and ibogaine (both drugs remain Schedule I* controlled substances). It also calls for development of a mechanism for patient access under the Right to Try Act which allows individuals who are terminally ill to access experimental drugs outside of existing regulatory pathways.
Cannabis policy: federal rule and broader rescheduling process
- As the broader rescheduling of marijuana from Schedule I to Schedule III* awaits a new administrative hearing process, the DOJ issued a targeted cannabis final order that places FDA-approved cannabis products and certain state-licensed medical cannabis products into Schedule III. Importantly, this rule does not broadly reclassify marijuana itself.
*A Schedule I classification means the federal government considers a substance to have no currently accepted medical use, a high potential for abuse, and no accepted safety for use under medical supervision. Moving a substance from Schedule I to Schedule III means it is recognized as having accepted medical use and a lower abuse risk, and it also allows prescribing under federal law, standard pharmacy distribution, and significantly fewer research barriers.
State legislation to know
New Jersey: APRN independent practice
- SB 2996 was signed on March 30, 2026 and, as stated in the bill text, eligible APRNs may now practice independently after more than 5,000 hours of licensed, active advanced nursing practice in the applicable population focus when delivering primary care or psychiatric-mental health services.
ANA 2026 policy priorities released
- ANA’s 2026 Regulatory and Policy Priorities have been released and highlight workplace violence prevention, APRN practice barriers, staffing, student loan access, payment policies that account for nursing care, and nursing research and workforce support.
Published April 2026.
This summary was informed by human-guided AI tools. Readers are encouraged to review the supporting links for full information.
