February 10, 2021

States Advance Breast Cancer Screening and Scope of Practice Legislation

Committees within state legislatures advance bills that would lower eligibility requirements for breast cancer screening coverage and modify physician assistant (PA) and advanced practice registered nurses (APRN) supervision requirements.

Breast Cancer Screening

In Hawaii, HB 309 passed the Health, Human Services, and Homelessness Committee. It would expand coverage for breast cancer screening by low-dose mammography, provided the woman has an above-average risk for breast cancer as determined by using a risk-factor modeling tool, as follows:

  • For women age 35 to 39, including an annual baseline mammogram;
  • An annual mammogram for women over age 30, deemed by a licensed physician or clinician to have an above-average risk for breast cancer; and
  • For women of any age, any additional or supplemental imaging, such as breast magnetic resonance imaging or ultrasound, deemed medically necessary by an applicable American College of Radiology® guideline.

The bill would expand the definition of “low-dose mammography” to include both digital mammography and digital breast tomosynthesis and interpreting and rendering a report by a radiologist or other physician based on the screening. Digital breast tomosynthesis would be defined as “a radiologic procedure that involves the acquisition of a projection of images over the stationary breast to produce cross-sectional digital three-dimensional images of the breast.”

In Kansas, HB 2241 was referred to the Committee on Insurance and Pensions. It would mandate carriers that provide coverage for breast cancer diagnostic exams to cover breast cancer screening exams using diagnostic mammography, MRI or breast ultrasounds.

In New York, SB 3268 was referred to the Insurance Committee. The bill would lower the age of eligibility for an annual mammogram from 40 to 30 years old. Coverage eligibility would be lowered for enrollees aged 25–29, from 35–39 for single baseline mammograms. It would also require coverage for follow-up diagnostic testing for abnormal mammograms as determined by a physician.

In Oklahoma, SB 1027 was referred to the Retirement and Insurance Committee. In the event an enrollee’s previous low-dose mammography screening demonstrated dense breast tissue, the bill would require the carrier to cover a four-dimensional breast MRI in lieu of a low-dose mammography screening. The coverage would be available for women 35 years and older.

Scope of Practice

In Georgia, HB 213 had its second reading in the House. The bill seeks to permit APRNs to order, prescribe, procure, administer, dispense or furnish a diagnostic study or radiographic imaging test. Diagnostic study is defined as “a laboratory test, X-ray, ultrasound or procedure used to identify a characteristic or distinguishing feature of a particular disease or condition.” Radiographic imaging test includes a CT, MRI, PET or nuclear medicine.

In Mississippi, HB 1303 passed the House chamber. The bill seeks to exempt APRNs from having to contract with a physician after 3,600 hours of practice.

In South Dakota, HB 1163 was referred to the Health and Human Services Committee. The bill seeks to change the practice agreement between a physician assistant and physician from supervising to a collaborating agreement. PAs would also be permitted to delegate and assign therapeutic measures to assistive personnel.

In Utah, SB 27 passed the Health and Human Services Committee. The bill seeks to change the practice agreement between a PA and physician from a supervising to a collaborating agreement. The measure seeks to permit PAs to order, perform and interpret diagnostic studies and therapeutic procedures. The Utah Radiological Society is closely tracking the development of this measure. The Society is in the process of educating the committee members to clarify that PAs may order diagnostic procedures, and specifically for radiologic procedures, utilize the findings or results in treating the patient.

In Wyoming, SF 33 was referred to the Corporations, Elections and Political Subdivisions Committee. The bill seeks to change the practice agreement between a physician assistant and physician from supervising to a collaborating agreement.


 In Washington, SB 5222 was referred to the Senate Committee on Health and Long-Term Care. The bill seeks to require carriers to reimburse APRNs at the same rate as physicians for the same services.