On June 14th, 2019, the Medicare Payment Advisory Commission (MedPAC) issued its annual June report to Congress, Medicare and the Health Care Delivery System, containing two recommendations related to advanced practice registered nurses (APRN) and physician’s assistants (PA). First, MedPAC recommended that Congress should eliminate “Incident-to billing” for services provided by APRNs and PAs to provide the potential benefits of reducing overall Medicare spending, increasing beneficiary access, enhancing the ability to research the quality of care provided by APRNs and PAs, and improve the ability of Medicare Administrative Contractors to monitor program integrity. MedPAC estimates this change could reduce Medicare spending between $1 billion and $5 billion over the next five years. Second, MedPAC recommended that the Secretary of HHS should refine Medicare specialty designations for APRNs and PAs.