In this legislative session, state lawmakers appear to be emphasizing consumer protections and expanded mandated access to screening exams in bills potentially affecting medical imaging. Scope of practice legislation in several states would allow physician assistants, physical therapists or advanced practice nurses to order imaging exams.
More states are considering or adopting mandates for breast density disclosure, expanded mammography benefits, mechanisms to address or mediate payments for out-of-network health care services, and expanded scope of imaging practice.
In Oklahoma, SB 443 cleared both chambers. The bill would require health care facilities to send summaries of mammography reports by electronic mail upon request.
If the facility determines that a patient has heterogeneously or extremely dense breast tissue, the summary of the mammography report shall include the following notice:
"Your mammogram indicates that you have dense breast tissue. Dense breast tissue is common and is found in more than fifty percent (50%) of women and is not abnormal. However, dense breast tissue may make it more difficult to detect breast cancer and may be associated with an increased risk of breast cancer. This information is being provided to raise your awareness and to encourage you and your health care provider to discuss this and other breast cancer risk factors. Together, you and your health care provider can decide if additional screening options may be right for you. A report of your results was sent to your health care provider.”
In Colorado, HB 1301 was introduced last week and is scheduled for a hearing at the House Health and Insurance Committee. The bill would mandate coverage for preventive breast cancer screening studies defined as: a mammogram for individuals at average risk, a mammogram using a noninvasive imaging modality as recommended by the health provider or a mammogram and medically recommended subsequent noninvasive imaging modality for patients at average risk with incomplete mammogram results or for high-risk patients.
If enacted, the bill would also cover any cost-sharing expenses for any noninvasive imaging modality recommended by the health provider. It would mandate coverage for annual breast cancer screenings for all individuals who have at least one of the following breast cancer risk factors: prior family history, 40 years or older or an increased lifetime risk determined by a risk factor model.
In Hawaii, SB 1034 passed the state House. It would amend the existing health insurance mandate to specify that coverage of low-dose mammography includes coverage for digital mammography and breast tomosynthesis.
In Connecticut, HB 7124 and SB 838 are scheduled for discussion in their respective chambers. Both bills would provide coverage for mammograms or digital breast tomosynthesis (DBT) for women ages 30 or older. The bills would also cover annual mammograms when recommended by a physician if the patient has a family or personal history with breast cancer or if the patient has a prior history of breast disease. If enacted, additional provisions would provide coverage for ultrasound screenings if a mammogram demonstrates heterogeneous or dense breast tissue or if the patient is deemed to be at high risk for breast cancer.
In Illinois, SB 162 is scheduled for a third reading in the Senate. It would expand coverage to diagnostic mammograms when deemed medically necessary and would cover breast ultrasounds for evaluating dense breast tissue.
Certificate of Need
In Alaska, SB 1 would repeal the certificate of need program for health care facilities. The bill cleared the Senate Health and Social Services Committee and was referred to the Finance Committee.
In Alabama, HB 11 is scheduled for a hearing at the House Insurance Committee. The bill would require hospitals to seek reimbursement directly from the patient’s health insurer, except for copayments and deductibles.
In Colorado, HB 1174 is scheduled for a hearing before the Senate Judiciary Committee. The bill would require health insurance carriers, health care providers and health care facilities to inform enrollees about services by out-of-network providers and in-network and out-of-network facilities. The bill would establish the reimbursement amount for out-of-network providers that provide health care services to covered persons at an in-network facility and for out-of-network providers or facilities that provide emergency services to covered persons.
In Missouri, HB 756 cleared the House chamber. It would mandate health care providers to send any claim for out-of-network charges to the insurer within 180 days of out-of-network care. If enacted, reimbursements not agreed to between the two parties would require arbitration wherein the arbitrator would determine an amount between 120 percent of the Medicare allowed amount and 70th percentile of the usual and customary rate for unanticipated out-of-network care.
New Mexico’s Gov. Michelle Lujan Grisham signed into law SB 337. For emergency care, the law will require health insurers to reimburse out-of-network providers and will not require prior authorization. Patients will not be responsible for charges and fees for covered elective services by out-of-network providers if participating providers are unavailable at an in-network facility. Insurers will reimburse out-of-network providers at 60th percentile of the allowed commercial reimbursement rate for the particular health care service in the same or similar specialty in the same geographic area and no less than 150 percent of the Medicare rate.
Scope of Practice
In California, SB 697 would expand the scope of practice of physician assistants (PAs) to include ordering, performing, and interpreting diagnostic studies and therapeutic procedures. If enacted, PAs would also be allowed to supervise therapeutic and diagnostic measures for licensed or unlicensed personnel. The bill is scheduled for a hearing April 22.
In Florida, HB 821 is scheduled for a hearing before the House Health and Human Services Committee. The bill would expand the scope of advanced practice registered nurses by allowing them to order diagnostic tests.
North Dakota’s Gov. Doug Burgum signed HB 1175 into law. The law allows PAs to order and evaluate a diagnostic study and therapeutic procedures. Sen. Frank Lombardi introduced SB 774. It would expand the definition of physical therapy to include ordering diagnostic imaging and studies.
In South Carolina, SB 132 is scheduled for a hearing before the House Medical, Military, Public and Municipal Affairs Committee. The bill expands the scope of PAs to include ordering diagnostic, therapeutic and other medical services.