August 18, 2020

States Consider Out-of-Network Billing and Scope of Practice

Michigan’s Senate chamber deliberates a bill that would modify out-of-network provider reimbursement. Alabama extends an emergency rule permitting physician assistants to practice without direct supervision while California considers its scope of practice expansion for nurse practitioners.

Out-of-Network Billing

In Michigan, SB 570 would amend the state’s Public Health Code. In the event a patient is receiving emergency care by an out-of-network provider, SB 570 would reimburse out-of-network providers the greater of:

  • The average amount negotiated by the enrollee’s healthcare plan with in-network providers excluding in-network coinsurance, copayments or deductibles; or
  • 150% of the Medicare reimbursement amount, excluding in-network coinsurance, copayments or deductibles.

The bill is scheduled for a second reading on the Senate floor.

Scope of Practice

In Alabama, the State Board of Medical Examiners extended its Emergency Rule 540-X-7-.70 ER, which permits a physician assistant to provide emergency medical treatment without direct physician supervision to patients suffering from and affected by COVID-19, provided that the treatment is within the scope of the PA’s education and training.

The effective date of the rule was July 20, 2020 and will expire after 120 days.

In California, AB 890 is scheduled for a hearing before the Senate Appropriations Committee. The measure seeks to remove the mandatory physician supervision of nurse practitioners and to expand their scope of practice. The California Radiological Society is diligently working toward an amendment and is doing everything in its power to educate the stakeholders on provision of quality diagnostic imaging services. For questions, please contact Eugenia Brandt at