February 17, 2021

State Legislators Address High-Priority Imaging Issues

Breast cancer screening advances in Florida, Georgia and Hawaii, meanwhile West Virginia’s House passes a bill that modifies out-of-network billing. Several states hold hearings on bills affecting supervision requirements for physician assistants (PAs) and advanced practice registered nurses (APRNs).

Breast Cancer Screening

In Florida, SB 1038 was referred to the Committees on Banking and Insurance, Health Policy, and Appropriations. It would mandate carriers to cover diagnostic mammograms, breast MRIs and breast ultrasounds.

In Georgia, SB 103 was read in the Senate chamber. The bill would require carriers that cover for breast cancer screening examinations to cover breast cancer diagnostic examinations. Diagnostic examinations is defined as “mammography, MRI or ultrasound as deemed medically necessary and appropriate by a licensed healthcare professional to evaluate an abnormality in the breast that is:

  • Seen or suspected from a screening examination for breast cancer;
  • Detected by another means of examination; or
  • Suspected based on the personal medical history, family medical history, or high breast density of the individual.”

In Hawaii, SB 827 will be discussed before a hearing at the Senate Committee on Health. It would expand coverage for breast cancer screening by low-dose mammography 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.

Additionally, providers of healthcare services specified under this section would be reimbursed at rates accurately reflecting the resource costs specific to each modality, including any increased resource cost as of Jan. 1, 2021.

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: the means a radiologic procedure that allows a volumetric reconstruction of the whole breast from a finite number of low-dose two¬-dimensional projections obtained by different X-ray tube angles, creating a series of images forming a three-dimensional representation of the breast.

Out-of-Network Billing

In West Virginia, HB 2005 passed the House chamber. It would mandate carriers to cover a healthcare service provided by an out-of-network physician or a facility-based provider at the usual and customary rate or at an agreed rate if the provider performed the services at a healthcare facility that is in-network.

The usual and customary rate is defined as “The median of the contracted rates recognized by the carrier as the total maximum payment, to include the cost-sharing amount imposed for such item or service and the amount to be paid by the carrier for the same or a similar item or service that is provided by a provider in the same or similar specialty and provided in the geographic region in which the item or service is furnished.” In the event an enrollee receives emergency out-of-network services, or services at an in-network or out-of-network facility on an emergency or urgent basis, the enrollee would pay the in-network rate.

Scope of Practice

In Arizona, SB 1271 passed the Health and Human Services Committee. It would seek to permit associate physicians to enter into collaborative practice agreements with physicians.

In Florida, HB 431 was referred to the Subcommittees on Professions and Public Health and Health Care Appropriations. The bill seeks to change the practice agreement between a physician assistant and physician from supervising to a collaborating agreement.

In Kansas, HB 2256 and SB 174 would seek to permit APRNs to order and interpret diagnostic procedures. After completing 4,000 hours of clinical practice hours or clinical instructional hours within four years in a collaborative practice with a physician or a full practice authority APRN, the bill seeks to permit APRNs to have full practice authority.
The House bill will be heard before the Health and Human Services Committee, and the Senate version will be heard before the Public Health and Welfare Committee.

In Montana, HB 400 will be heard before the Human Services Committee. The bill seeks to change the practice agreement between a physician assistant and physician from supervising to a collaborating agreement. Additionally, it would permit PAs to supervise, delegate and assign therapeutic and diagnostic measures.

In Tennessee, HB 1080 and SB 671 would seek to permit PAs to order, perform and interpret diagnostic studies and therapeutic procedures. The House bill passed its first reading in the House chamber. The Senate companion bill passed its second reading in the Chamber and was referred to Senate Commerce and Labor Committee.