January 08, 2016

State Legislatures Address Key Imaging issues

From scope-of-practice to teleradiology, the nation’s 50 state legislatures will address many issues affecting the cost, quality and access to medical imaging services in 2016. In this report, Eugenia Krimer Brandt, the ACR’s director of state legislative and regulatory affairs, evaluates nine areas of particular interest.

Radiology Scope-of-Practice

Scope-of-practice in radiology has historically focused on making sure that individuals who perform radiological procedures have the requisite training and education to ensure quality exams. The ACR strongly believes that anyone who performs radiology services must have an appropriate level of education and training to provide quality services to patients. Recently, multiple proposals relating to ordering and interoperation of diagnostic imaging studies by ancillary personnel have been identified. Additional bills seeking expansion of ancillary personnel scope of practice into the areas of diagnostic imaging use, ordering and interpretation are expected during the upcoming legislative session.

Radiation Control and Patient Safety

The ACR and its chapters are committed to working with the states to meet radiation protection and radiation control goals to assure the best radiological care for patients. States may see proposals related to medical physicist licensure and registration as well as regulatory proposals to improve radiological safety. We also expect to see legislation related to radiologic technologist licensure or the legal recognition of radiologist assistants in 2016.

Inappropriate Utilization

The ACR recognizes the inappropriate utilization of a diagnostic or therapeutic medical procedures diminishes health care quality and effectiveness while adding wasteful costs. The College opposes physician self-referral. It supports legislative efforts prohibiting reimbursement for any diagnostic or therapeutic procedure carried out in a facility in which the referring physician has a direct or indirect financial interest.
Breast Density Information

At the end of 2015, laws were on the books in 24 states for mandatory disclosure or for breast density notification. Additional state legislative activity calling for breast density disclosure or notification is expected in 2016. Legislation is pending in Iowa, Kentucky, Georgia, Florida, Oklahoma, South Carolina, Vermont and Washington. Additionally, bills mandating coverage for breast tomosynthesis or for breast ultrasound/MRI following dense breast tissue finding may be filed.

Certificate of Need

The ACR recommends that all radiological equipment should be under the direction of a radiologist to provide for the highest level of patient care and adequate radiation protection. States with strict CON statutes in place can expect legislative challenge from stakeholders interested in eliminating regulatory restrictions against capital expenditure and/or new equipment purchases.


The Affordable Care Act (ACA) lowered Medicaid eligibility requirements, enabling millions more Americans to qualify for the federally subsidized, state-operated health insurance program. A majority of states have opted to expand Medicaid to cover all non-Medicare eligible individuals with incomes up to 133 percent of the federal poverty level. In addition to the issues of Medicaid expansion and reimbursement, there are matters of Medicaid delivery and payment reform. It is of utmost importance that physicians remain actively involved in the development and implementation of new delivery system and/or payment models.

Many states have not increased Medicaid provider rates in years. The relationship between Medicaid service delivery and provider reforms are notably intertwined. Although all state Medicaid programs cover guideline-recommended cancer screening services, screening rates for Medicaid recipients are lower than comparable privately insured patients. Moreover, state variation in Medicaid eligibility requirements and reimbursement for medical services has been shown to affect utilization of health services. A study of this disparity (Michael Halpern et al., Cancer, October 2014), showed that increased Medicaid reimbursement for office visits was consistently associated with an increased likelihood of a patient being screened for cancer. Researchers concluded that Medicaid reimbursement may be an important policy tool for increasing screening among the Medicaid population, who are less likely to be screened for cancer and more likely to present with advanced stage cancer than those with other insurance. Therefore, issues of Medicaid reimbursement are likely to be brought up during 2016 legislative session.

Clinical Decision Support

The ACR urges physicians to advocate for the introduction of computerized decision support (CDS) systems as alternatives to the prior authorization process used by Medicaid and private insurance providers in many states. CDS systems are complex applications designed to help clinicians make accurate diagnostic and therapeutic ordering decisions for patients in their care. They can simplify access to data needed to make an informed diagnosis and can deliver reminders and prompts at the time of a patient encounter. Decision support systems can save the clinician’s time and have been shown to be highly effective when operating in fast-paced medical environments.

Physician payment

Since the implementation of the state health exchanges under the Affordable Care Act, some insurers limited the number of physicians in their networks for health insurance products sold on the exchanges. Such narrow networks are a way to control costs for products sold in the state exchanges. The College anticipates that legislation related to increasing the transparency of narrow-networks, the availability of provider directories and billing for services by out-of-network hospital providers will be introduced and debated in selected states this year.

The ACR continues to support existing state licensure requirements for the regular practice of medicine across state lines using store-and-forward teleradiology.

For more information, contact Eugenia Krimer Brandt at ekrimer@acr.org.