As states convene for their legislative sessions, there are many bills of interest to American College of Radiology® (ACR®) members. To kick off the legislative year, states are considering bills related to breast cancer screening, out-of-network billing and scope of practice.
Breast Cancer Screening
In Florida, House Bill (HB) 917 was referred to the Finance and Facilities Subcommittee. If enacted, the bill would prohibit carriers that cover diagnostic mammograms, breast magnetic resonance imaging (MRI) scans or breast ultrasounds from applying cost-sharing requirements when such service is ordered by an enrollee’s healthcare provider.
Also in Florida, HB 1175 and Senate Bill (SB) 1460 would require facilities to provide patients with an informed consent form before performing a mammogram to be signed by the patient. The facility must notify a patient of the form at the time of scheduling the patient's appointment and post the form on its website.
In New York, SB 3268 was referred to the Senate Insurance Committee. If passed, the bill would lower the age of eligibility for an annual mammogram from 40 to 30 years of age. Coverage eligibility would be lowered for enrollees aged 25–29 from 35–39 for single baseline mammograms, which may be provided by breast tomosynthesis. It would also require coverage for follow-up diagnostic testing for abnormal mammograms as determined by a physician.
The New York State Radiological Society is monitoring the bill.
In Washington, SB 5716 was filed in the Senate. If enacted, insurance carriers would be required to cover supplemental breast MRIs for women at high risk of developing breast cancer without cost sharing.
Out-of-Network Billing
In New Jersey, Assembly Bill (AB) 6245 was amended before being passed by the Assembly Health Committee. The bill would revise certain aspects of the state’s out-of-network billing arbitration processes for claims involving carriers subject to the provisions of the law, including:
- Extending the amount of time that the carrier and healthcare provider must negotiate a settlement in the event of an inadvertent use of out-of-network services from 30 to 60 days.
- Extending the deadline for the carrier, provider, or enrollee to initiate binding arbitration in the event of a failure to reach a settlement from within 30 days of the final offer to within 90 days of the final offer.
- Changing the initiation of binding arbitration to require the difference between a carrier's and provider's final offers be $1,000 or higher for a billed amount of $2,500 or more or $500 or higher for a billed amount of less than $2,500.
- Changing the certification requirement for arbitrators from a certification from the American Arbitration Association to a certification from the Department of Banking and Insurance.
- Requiring an arbitrator to include detailed written findings with each decision through an analysis of the decision including, but not be limited to, information concerning any databases, previous awards, or other documentation or arguments that contributed to the arbitrator's decision.
The Radiological Society of New Jersey is monitoring the bill.
Scope of Practice
In California, SB 377 will be considered by the Appropriations Committee Jan 18.. The bill would prohibit a person from becoming a radiologist assistant unless the person meets specified requirements, including examination and registration. The bill would prohibit a radiologist assistant from functioning in a capacity independent of a supervising radiologist and performing specified acts.
The California Radiological Society is monitoring the bill.
In Indiana, SB 250 was referred to the Committee on Health and Provider Services. It would require Advanced Practice Registered Nurses (APRN) who collaborate with licensed practitioners to operate within a 75-mile radius of the licensed practitioner's primary practice location or residence. Additionally, the APRN and the APRN's collaborating practitioner must meet quarterly.
In Mississippi, HB 440 was referred to the Public Health and Human Services Committee. The bill would exempt APRNs from a collaborating practice agreement once the APRN has completed 3,600 practice hours.
In Missouri, HB 2296 would permit an assistant physician to practice as a physician once the assistant physician passes Step 3 of the United States Medical Licensing Examination and completes a five-year collaborative practice period.
The Missouri Radiological Society opposes the bill.
In New York, Assembly Bill 1837 and SB 1591 were referred to their respective Health Committees. According to the bills, a physician assistant (PA) would be permitted to use fluoroscopy for guidance of diagnostic and therapeutic procedures; provided that the PA has successfully completed an educational program consisting of at least 40 hours of didactic and 40 hours of clinical training with successful completion of a competency exam, as approved by the Department of Health.
Also in New York, SB 3056 was referred to the Higher Education Committee. The bill would permit nurse practitioners (NPs) to perform therapeutic measures in collaboration with a licensed physician or nurse practitioner. In addition, a certified nurse practitioner practicing for more than 3,600 hours would not be required to collaborate with a physician or NP.
The New York Radiological Society opposes all three scope measures.
For more information about state legislative issues, please contact Tina Getachew or Eugenia Brandt. To stay current on state legislative developments relevant to radiology, view the American College of Radiology® policy map.