April 04, 2019

States Debate Expanded Imaging Access

From Alaska to Florida and Connecticut to California, state legislatures from the four corners of the U.S. are considering bills that could significantly affect medical imaging practices across the nation.

The American College of Radiology’s weekly update features proposed bills in a dozen states that address cost and transparency, cancer screening, certificate of need and scope of practice. Out-of-network billing legislation is covered separately in this week’s Advocacy in Action eNews.

Cost and Transparency

In Tennessee, HB 419 and companion legislation SB 510 would both mandate insurance carriers to implement a program that provides incentives for health plan enrollees who elect to receive a comparable health care service from a network provider that is covered by the health plan. The average allowed amount must be based on the actual allowed amounts paid to network providers under the enrollee's health plan within a reasonable timeframe, not to exceed one year.

The House version was recently referred to the House Government Operations Committee. The Senate version is scheduled on the Senate Commerce and Labor Committee calendar.

In Florida, HB 1113 would authorize health insurers to provide a shared savings incentive programs in which insureds receive cash payment as incentive to save on certain nonemergency health care services. The bill is scheduled on the agenda at the House Health and Human Services Committee.

Cancer Screening

In Colorado, Rep. Dafna Michaelson Jenet introduced HB 1301. The bill would expand the current law covering one mammography exam per year by requiring coverage for breast cancer screening studies and subsequent breast imaging using the noninvasive imaging modality deemed appropriate for each individual determined by the individual's health care provider.

In Connecticut, HB 7124 was referred to the offices of Legislative Research and Fiscal Analysis. The bill would provide coverage for mammograms for women ages 30 or older, which may include digital breast tomosynthesis (DBT). It 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 it 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.

Louisiana’s Rep. Julie Stokes introduced HB 347. It would mandate coverage for diagnostic imaging at the same level of coverage provided for screening mammograms.

In Rhode Island, HB 5567 is scheduled for a hearing at the House Committee on Health, Education and Welfare. The bill would mandate insurance coverage for DBT screenings. Insurers would be required to pay for two mammography screenings per year when recommended by a physician for women who have been treated for breast cancer within the previous five years or have a genetic predisposition to breast cancer development.

If adopted, the bill also mandates all health care facilities that perform mammography or DBT screenings to inform patients about breast density findings from their procedures. The summary of the mammography report would include the following notice:

“Your mammogram indicates that you have dense breast tissue. Dense breast tissue is relatively common and is found in about forty percent (40%) of women. The presence of dense tissue can make it more difficult to detect cancers in the breast by mammography because it can hide small abnormalities and may be associated with an increased risk. Hence, you may benefit from supplementary screening tests, which may include a breast ultrasound screening, or a breast MRI examination, or both, depending on your individual risk factors.

We are providing this information to raise your awareness of this important factor and to encourage you to discuss your dense breast tissue, as well as other breast cancer risk factors, with your health care provider. Together, you can decide which screening options are right for you.

A report of your results was sent to your physician. You should contact your physician if you have any questions or concerns about this report."

Certificate of Need

In Alaska, SB 1 would repeal the certificate of need program for health care facilities. The bill was recently heard at the Senate Health and Social Services Committee.

Scope of Practice

In Alabama, SB 156 would expand the scope of practice of certified registered nurse anesthetists (CRNAs) to allow them to practice in coordination with a physician, rather than under a physician’s direction as stated under current law. The bill is scheduled to be heard at the Senate Healthcare Committee.

In California, AB 407 was referred to the Assembly’s Committee on Health for a second time. The bill would permit a physician, surgeon or a doctor of podiatric medicine to provide fluoroscopy services without a fluoroscopy permit or certification.

In Nevada, AB 328 would allow physician assistants to perform medical services without the supervision of a physician. If enacted, their scope would be expanded to include ordering, performing and interpreting a diagnostic test or a therapeutic procedure. Physician assistants would also be permitted to supervise, delegate and assign a diagnostic test or a therapeutic procedure to licensed or unlicensed personnel. Other provisions expand the state’s Board of Medical Examiners to include two physician assistants. It is scheduled for a hearing at the Assembly Committee on Commerce and Labor.

In North Dakota, HB 1175 cleared both chambers and is awaiting the governor’s signature. It would expand the scope of physician assistants to include ordering and evaluating diagnostic studies and therapeutic procedures.

In Texas, HB 1792 is scheduled for a hearing at the Health Professions Subcommittee. The bill would expand the scope of practice of advanced practice registered nurses to include ordering, performing and interpreting diagnostic tests.