February 09, 2023

State Legislatures Continue to Introduce Scope of Practice Expansion Bills

State legislatures continue to introduce healthcare-related legislation ranging from changes in licensure to non-physician scope of practice expansion.


Tennessee House Bill (HB) 1388 would eliminate the Radiologic Imaging and Radiation Therapy Board of Examiners and would move the licensing of all persons performing radiologic imaging, radiography or radiation therapy procedures in hospitals, outpatient diagnostic centers, recuperation centers, physicians’ offices or any other settings to the Tennessee Department of Health Division of Health-Related Boards.

Out-of-Network / Surprise / Balance Billing Bills

North Carolina

Senate Bill (SB) 46 would mandate that any in-network health service facility submit a written notice to a patient, at least 72 hours prior to any healthcare services if there are out-of-network providers who may be part of the provision of covered services. These notices would have to include the following:

  • All the healthcare providers that will be rendering services and are not participating as in-network healthcare providers in the insurer's network.
  • The estimated cost to the insured of the covered healthcare services being rendered by the out-of-network providers.


HB 1503 and SB 1345, which would address surprise billing, would make several changes to medical billing, including:

  • An insurer would be required to provide benefits for emergency medical services without the need for a prior authorization determination and retrospective payment denial for medically necessary services.
  • If an insured patient receives emergency or nonemergency medical services from a nonparticipating emergency medical provider, then the nonparticipating provider shall collect or bill no more than the person's deductible, coinsurance, copayment or other cost-sharing amounts as determined by the person's policy directly.
  • If an out-of-network provider or out-of-network facility concludes that payment received from an insurer is not sufficient given the complexity and circumstances of the services provided, then the provider or facility may initiate a request for arbitration with the Insurance Commissioner, within thirty of receipt of payment for the claim.

Scope of Practice

SB 1334 would enjoin the state of Arizona into the advanced practice registered nurse (APRN) Compact. This compact allows APRNs who meet its eligibility requirements to practice in other compact states.


SB 218 would allow a physician assistant (PA) to practice without a written collaborative agreement if the PA has completed at least 250 hours of continuing education or training and at least 2,000 hours of clinical experience.


House Study Bill 115 would repeal the requirement that a physician assistant (PA) practice under the supervision of a licensed physician.


HB 475 and SB 439 would enjoin the state of Maryland into the advanced practice registered nurse (APRN) Compact. This compact allows APRNs who meet its eligibility requirements to practice in other compact states.

New York

Assembly Bill 3391 would enjoin the state of New York into the interstate medical licensure compact and the nurse licensure compact. The interstate medical licensure compact allows physicians who meet the compact’s eligibility requirements to practice medicine in other compact states. The nurse licensure compact allows registered nurses (RN) and licensed professional nurses (LPN) who meet its eligibility requirements to practice in other compact states.

The New York State Radiological Society is monitoring this bill.


HB 1709 would permit an advanced practice registered nurse (APRN) to serve as a primary care provider to as many as 2,500 SoonerCare patients. SoonerCare is Oklahoma’s Medicaid program.

HB 2168 would allow a certified registered nurse anesthetist (CRNA), who also holds a valid certification in nonsurgical pain management, to practice interventional pain management. This would include the use of fluoroscopy. All of these services would have to be done in collaboration with a physician.

The Oklahoma State Radiological Society is opposed to both bills. 

Rhode Island

HB 5332 would enjoin the state of Rhode Island into the physician assistance (PA) licensure compact. This compact allows PAs who meet its eligibility requirements to practice in other compact states.

South Dakota

SB 175 would allow a physician assistant who has completed 2,080 practice hours, to practice without a collaborative agreement in the emergency department of a rural healthcare facility and in the following primary care areas: acute care, family medicine, general internal medicine, general pediatrics and geriatrics. This bill also states that before a PA may engage in any area of practice other than those listed above the PA must complete an additional 2,080 practice hours under a collaborative agreement with the employing healthcare facility. Once a PA has met these requirements, they would be allowed to perform a wide variety of medical services, including taking X-rays and performing radiologic procedures.

The South Dakota Radiological Society is opposed to the bill.



HB 1963 would require insurers, who provide coverage to patients within Oklahoma, to cover out-of-state telemedicine services provided that the out-of-state entity’s gross patient revenue is equal to or greater than one billion dollars and an Oklahoma licensed physician referred the patient to the out-of-state entity or provider.

The American College of Radiology® (ACR®) has partnered with Fiscal Note, a legislation and regulation tracking service, to provide continuous, comprehensive updates on radiology and healthcare-related legislation. To stay current on state legislative developments relevant to radiology, view the ACR policy map.

For more information about state legislative activities, please contact Eugenia Brandt, ACR Senior Government Affairs Director, or Dillon Harp, ACR Senior Government Relations Specialist.