April 25, 2019

States Debate Imaging Coverages, Restrictions and Billing Solutions

Several states are proceeding with bills concerning expanded coverage for various screening and diagnostic breast imaging procedures, less stringent scope of practice restrictions for advanced practice registered nurses (APRNs), a certificate-of-need repeal and possible out-of-network billing solutions.

Breast Cancer Imaging

In Colorado, HB 1301 cleared the state House of Representatives and is scheduled for a hearing before the Senate Health and Human Services 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. It would mandate coverage for annual breast cancer screenings for all individuals who have at least one breast cancer risk factor or prior family history of breast cancer. Women, who are at least 40 years, or who have an increased lifetime risk determined by a risk factor model, would also qualify.

In Louisiana, HB 347 is scheduled for a hearing before the House Insurance Committee. The bill would mandate coverage for diagnostic imaging at the same level of coverage provided for screening mammograms.

In Rhode Island, HB 6005, introduced last week, was held for further study after a hearing before the House Health, Education and Welfare Committee. The bill would mandate coverage for two mammogram screenings per year when recommended by a physician for women who have been treated for breast cancer within the last five years or are at high risk of developing breast cancer due to genetic predisposition or atypical ductal hyperplasia. Additionally, women who have been notified of having dense breast tissue would be covered for breast MRI exams and/or digital breast tomosynthesis screenings.

Scope of Practice

In Alabama, SB 165 is scheduled for a hearing before the Senate Healthcare Committee. The bill would establish the Alabama Medical Imaging and Radiation Therapy Board to regulate and provide licensure of limited X-ray machine operators, magnetic resonance technologists, nuclear medicine technologists, radiation therapists, radiographers and radiologist assistants.

Board members would include a licensed limited X-ray machine operator, a licensed magnetic resonance technologist, a licensed nuclear medicine technologist, a radiologist who supervises medical imaging or radiation therapy professionals, a licensed practitioner who is not a radiologist and supervises medical imaging or radiation therapy professionals, a licensed radiation therapist, a licensed radiographer, a licensed radiologist assistant and a public citizen.

In Florida, HB 821 cleared the House chamber. The bill would expand the scope of advanced practice registered nurses by allowing them to order diagnostic tests.

In Maine, LD 1406 is scheduled for a hearing before the Health Coverage, Insurance and Financial Services Committee. The bill would require licensed chiropractic assistants who perform X-ray procedures to be certified by the board as radiologic technologists.

In Oregon, SB 128 would direct the Oregon’s Board of Medical Imaging to issue permits that would allow qualified APRNs to supervise fluoroscopy under a physician’s supervision. The bill would also allow fluoroscopic X-ray equipment to be operated by a medical imaging licensee who specializes in radiography. The bill was held for a work session.

Certificate of Need

In Tennessee, HB 1085 and its Senate companion legislation SB 1291 would eliminate the requirement of a certificate of need for health care facilities. The House bill is scheduled for a hearing before the Finance, Ways and Means Subcommittee. The Senate version was assigned to the General Subcommittee of the Government Operations Committee.

Out-of-Network Billing

In Alabama, HB 11 passed the Senate Banking and 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 passed the Senate Finance and Appropriations Committees and is scheduled for the Senate floor. 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 mandate out-of-network providers and facilities to be reimbursed at 105 percent of the carrier’s median in-network rate in the previous year for the same service performed in a similar geographic area as determined by claims data from the state’s all-payer health care claims database.

In Washington, HB 1065 cleared both chambers. The bill would require coverage billed at in-network rates for emergency services that screen and stabilize enrollees and would prohibit prior authorization. It would prohibit balance billing directed to enrollees for elective services, including radiology, at in-network hospitals.