February 23, 2023

States, DC Address Certificate of Need, Prior Authorization and More

While states continue to consider bills related to scope of practice, the American College of Radiology® (ACR®) is also seeing bills introduced related to certificate of need, prior authorization and telemedicine. We are currently in the thick of legislative season with some states wrapping up their legislative session and a few states about to begin theirs, but rest assured your ACR state government relations team is always here to help!

Certificate of Need

West Virginia

Senate Bill (SB) 612 would create a three-year pilot program for the state legislature to evaluate whether allowing the acquiring, offering or developing of magnetic resonance imaging (MRI) and CT services in West Virginia in an ambulatory healthcare setting will drive down the need for West Virginia residents to travel out of state for these services. At the end of the three-year period, the findings will be presented the Legislative Oversight Commission on Health and Human Resources Accountability with a recommendation regarding whether the pilot program should be terminated, become permanent or call for further study.

Prior Authorization

District of Columbia

Bill 25-0124 would make the following changes regarding prior authorization:

  • When a prior authorization is granted or denied, the notification must be made within 24 hours of the determination.
  • Adverse determinations must include grounds for denial and appeals information.
  • Prior authorizations shall be valid for one year, with the exception that prior authorizations for long-term or chronic conditions last for the length of the treatment.
  • Adverse determinations must be made by a physician licensed in DC and of the same specialty.

Finally, and perhaps most importantly, the bill would prohibit insurers from requiring prior authorization for a treatment based solely on cost.

Scope of Practice

South Dakota

SB 175 would have allowed a physician assistant (PA) who has completed 2,080 practice hours to practice without a collaborative agreement in the emergency department of a rural healthcare facility and the following primary care areas: acute care, family medicine, general internal medicine, general pediatrics and geriatrics. This bill also stated 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.

SB 175 failed in the Senate. The bill was opposed by the South Dakota Radiological Society.


House Bill (HB) 727 and SB 673 would allow a PA to perform non-fluoroscopic X–ray procedures and “perform X-ray duties” without a license if they have:

  • Taken 30 hours of training in performing X–ray procedures.
  • Successfully passed an exam based on performing X-ray procedures.
  • Completed a course that includes anterior-posterior and lateral radiographic studies of extremities on at least 20 separate patients under the direct supervision of the delegating physician or radiologist using a mini C-arm or similar low-level radiation machine.

The Maryland Radiological Society is opposed to both bills.

New Mexico

SB 412 would permit a physical therapist to order MRI examinations to aid in the diagnosis and treatment of physical therapy patients.

New York

Assembly Bill 4552 would enjoin the state of New York into the nurse licensure compact and the advanced practice registered nurse (APRN) compact. The nurse licensure compact allows registered nurses (RN) and licensed practical nurses (LPN) who meet its eligibility requirements to practice in other compact states. The APRN compact allows APRNs who meet its eligibility requirements to practice in other compact states.

Rhode Island

SB 278 would enjoin Rhode Island into the PA licensure compact. This compact allows PAs who meet its eligibility requirements to practice in other compact states.

West Virginia

SB 698 would change the title of a physician assistant to a physician associate. It would also change the relationship between a physician and a PA from supervisory to collaborative.


District of Columbia

Bill 25-0125 would enjoin the District of Columbia into the Uniform Telehealth Act. This act, which was created by the Uniform Law Commission (ULC), allows specialty physicians to consult directly with patients in states that have adopted the act.

The College 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. You can also access information and ACR resources about scope of practice.

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