January 28, 2022

States Focus on Breast Cancer Screening, Scope and Out-of-Network Bills

Hawaii introduces a measure expanding coverage of breast cancer screening. New Hampshire and Tennessee address bills modifying out-of-network billing provisions. Several states advance bills expanding scope of practice for advanced practice registered nurses (APRNs) and physician assistants (PAs).

Breast Cancer Screening

In Hawaii, legislation (Senate Bill (SB) 2635) was introduced that would require carriers to cover mandated services for mammography at least as favorably as coverage for other radiological examinations.

Scope of Practice

In Colorado, House Bill (HB) 22-1095 was referred to the Health and Insurance Committee. The bill sponsors seek to permit physician assistants (PAs) who have completed 3,000 or more practice hours to practice without physician supervision. The Colorado Radiological Society opposes the bill.

In Illinois, SB 3196 was introduced and assigned to the Committee on Assignments. This bill would allow advanced practice registered nurses (APRNs) licensed under the Nurse Practice Act and that practice in a hospital, hospital affiliate or an ambulatory surgical center to administer radiation through a fluoroscope without supervision, prescription or direction of a licensed person. The Illinois Radiological Society opposes the bill.

In Tennessee, HB 184 will be considered by the Health Subcommittee. If enacted, the bill would permit APRNs to initiate a therapeutic regimen that includes ordering diagnostic services. The Tennessee Radiological Society opposes HB 184.

In Hawaii, SB 2680 was introduced. If enacted, the bill would permit APRNs to order and perform therapeutic measures.

Also in Hawaii, HB 1575 passed its first reading in the House, and its companion bill, SB 2445 was introduced in the Senate. The bills would expand the definition of a patient’s provider to include PAs.

Out-Of-Network Billing

In Tennessee, SB 1 will be considered before the Senate. If enacted, the bill would mandate that when a carrier receives a bill for emergency services from an out-of-network facility-based physician or facility, the carrier would pay an amount that it determines is reasonable for the emergency services rendered by the provider and ensure that the enrollee incurs no greater out-of-pocket costs for the emergency services than the enrollee would have incurred had the services been performed by an in-network physician or healthcare facility. The Insurance Commissioner would establish an independent dispute resolution process by which a dispute for a bill for out-of-network emergency services or a balance bill may be resolved. In the event the provider and carrier do not agree on a settlement, the independent dispute resolution entity may direct both parties to attempt a good faith negotiation for settlement.

The Tennessee Radiological Society supports the measure.

In New Hampshire, SB 287 will be considered by the Health and Human Services Committee. If enacted, the bill would define the out-of-network rate as the amount agreed to through open negotiations or the amount determined by the Insurance Commissioner.

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. Members can opt in for Fiscal Note reports by contacting Eugenia Brandt, ACR Director of State Government Affairs. For more information about the bills listed above or any other state legislative issue, members may also contact Tina Getachew. To stay current on state legislative developments relevant to radiology, view the American College of Radiology® policy map.