Many state legislatures are still debating a wide variety of healthcare-related legislation, but the American College of Radiology® (ACR®) saw a scope of practice victory in New Mexico.
Scope of Practice
New Mexico
Senate Bill (SB) 412 would have permitted a physical therapist to order MRI examinations to aid in the diagnosis and treatment of physical therapy patients.
After passing out of the Senate Health and Public Affairs Committee, the bill failed to move out of its next committee, the Senate Judiciary Committee, and can no longer be considered for this legislative cycle.
Alaska
House Bill (HB) 149 would enjoin the state of Alaska into the Nurse Licensure Compact (NLC). This compact allows registered nurses (RN) and licensed practical nurses (LPN) who meet its eligibility requirements to practice in other compact states.
Certificate of Need
Pennsylvania
SB 545 would require a healthcare practitioner who is performing a diagnostic imaging (DI) service and believes that a significant abnormality exists to directly notify the patient or the patient’s designee that a completed review of the patient’s test had been completed and the results sent to the practitioner who ordered the DI. The practitioner performing these services would also be required to include the following when sending their report: name of the performing practitioner, date the test was performed and date the results were sent back to the ordering practitioner.
This bill would also provide exceptions, to this rule, for the following:
- Routine obstetrical ultrasounds used to monitor the development of a fetus.
- DIs performed on a patient who is being treated on an inpatient basis or in an emergency room.
- Diagnostic radiographs.
- DIs performed on a patient with a chronic condition if the patient has previously received notice of the chronic condition or DIs test results who are provided their test results at the time of the test.
The Pennsylvania Radiological Society supports this bill.
Out-of-Network/Surprise/Balance Billing
Maine
House Paper 868 would require an insurer, offering Medicare supplement insurance, to disclose whether the Medicare supplement insurance plan covers the costs of Medicare Part B excess charges. This bill would also prohibit a physician from balance billing Medicare beneficiaries for any amount above the Medicare-approved amount for a service, procedure, or treatment.
Telemedicine
Massachusetts
HB 3585 states that telehealth services may include utilization review to determine the appropriateness but that the determination shall be made in the same manner as if the service was delivered in person. This bill mandates that carriers could not impose any prior authorization requirements to obtain medically necessary health services via telehealth that would not apply to the receipt of those same services on an in-person basis.
Utilization Management
Louisiana
SB 110 would make the following changes regarding insurance utilization management tools:
- Requires an expeditious review (within 36 hours) when a patient’s health condition requires such, for any procedure, pharmaceutical or diagnostic test when/if the patient has a history of cancer, symptoms that indicate the possibility of a cancer diagnosis, or has an ongoing case involving cancer, and the procedure, pharmaceutical or diagnostic test is related to that cancer.
- Prohibits a health insurer, that provides coverage for cancer, from denying a utilization review or payment of claims for any procedure, pharmaceutical or diagnostic test, if the patient presents symptoms that indicate a cancer diagnosis or has an ongoing case involving cancer if the procedure, pharmaceutical or diagnostic test is related to that cancer.
- Prohibits a health insurer, that provides coverage for cancer, to deny coverage of a positron emission tomography (PET) or other recommended imaging for diagnosis, treatment, appropriate management, restaging, or ongoing monitoring of a patient’s disease or condition, if the patient has a prior history of cancer or the patient’s symptoms indicate the possibility of a cancer diagnosis, and the PET or other recommended imaging is recommended.
The ACR has partnered with Fiscal Note, a legislation and regulation tracking service, to provide continuous, comprehensive updates about radiology and healthcare-related legislation. To stay current regarding state legislative developments relevant to radiology, view the ACR policy map. You can also access information and ACR resources there about scope of practice.
For more information about state legislative activities or if you need any guidance on legislation in your state, contact Eugenia Brandt, ACR Senior Government Affairs Director, or Dillon Harp, ACR Senior Government Relations Specialist.