August 14, 2019

States Consider Scope and Out-of-Network Legislation

As California and Massachusetts consider bills regarding scope of practice, Pennsylvania’s legislature re-introduces an out-of-network bill requiring an independent dispute resolution process.

Scope of Practice

In California, the Assembly Committee on Appropriations will hold a hearing on SB 697. The bill would modify the definition of “supervision” of physician assistants (PAs) to the following:

  • Require adequate supervision as agreed to in the practice agreement
  • Require that the physician and surgeon be available by telephone or other electronic communication method at the time the physician assistant examines the patient
  • Allow the Physician Assistant Board to require the physical presence of a physician and surgeon as a term or condition of a PA’s reinstatement or probation

In Massachusetts, SB 716 was referred to the Joint Committee on Health Care Financing. The bill would expand the scope of practice for certified nurse anesthetists to include interpreting tests and evaluating treatment and therapeutics.

Out-Of-Network Billing

In Pennsylvania, SB 822 was introduced by Sen. Judith Schwank. The bill would prohibit out-of-network billing for emergency care and require health care providers to issue a written disclosure informing the patient of receiving out-of-network care prior to receiving service. In the event an enrollee receives an out-of-network bill, the insurer and provider would reach agreement to an additional amount to be paid for the provider's health care services, which could include applicable in-network provider cost-sharing amount owed by the insured. If the provider and insurer did not reach agreement on a payment amount, either party could submit the dispute to an independent dispute resolution process, in which an arbitrator would make a decision.