The 2016 state legislative season featured a wide range of hotly debated clinical, economic and legal issues that affect radiology practice.
The American College of Radiology (ACR) tracked more than 250 radiology-relevant bills addressed by the state legislatures in 2016. As shown on the legislative calendar, all but nine states had wrapped up this year’s legislative activity by July 20. See a state-by-state mapped report.
Many states considered legislation that proposed modifications to their regulation of medical business practices. They considered the growing trend of health care facilities directly employing physicians, proposed modifications to Certificate of Need (CON) regulations that control the growth of hospital infrastructure and medical device acquisition, gross receipt taxes on medical providers and facilities, the proliferation of specialty care centers and the inappropriate medical imaging utilization.
The CON issue was hotly debated in North Carolina and Virginia. Bills on patient referrals and utilization management were considered in 11 states (Delaware, Georgia, Iowa, Illinois, Massachusetts, Maryland, Minnesota, Mississippi, New Jersey, New York, Pennsylvania), and specialty hospitals drew legislative attention in North Carolina, West Virginia and Wyoming.
Network Adequacy and Out-of-Network Payment
Health insurers set and adjust the number of providers in their managed care networks, but they often limit the number of providers within their networks to control costs or maintain affordable premiums. As a result, carriers will create narrow provider networks that may offer beneficiaries authorized access to few specialty providers. Narrow networks are an accepted way of operating a preferred provider organization (PPO) on a set budget, but inadequate networks result in a cascading effect of problems for both patients and providers. State legislatures are addressing this issue by enacting laws to ensure that provider networks established in their respective states are “adequate” to provide reasonable access to primary care and specialty physicians for their members. View a list of network adequacy statutes in 28 states and the District of Columbia.
State-level policymakers have to balance the multi-faceted interests of stakeholders. Patients are becoming more educated about their choice of providers within the advertised network. Insurers are closely tracking the profitability of their product offering and are constantly re-evaluating their matrices of in-network providers and hospitals. Physicians and hospitals, seeking to be participating as in-network parties with an insurer, are examining the fairness of contract offerings available to them.
Lawmakers at the state level have become increasingly interested in introducing the legislation based on the Network Adequacy Act, a model bill from National Association of Insurance Commissioners (NAIC) that addresses the shortcomings of narrow-network PPOs. New York (NY A9205) and Texas (TX SB 481) passed balance billing laws in 2014 and 2015, respectively. In 2016, various bills on network adequacy, transparency and out of network provider billing legislation were under consideration in 25 states (California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, New Hampshire, New Jersey, New York, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Utah, Washington and West Virginia.)
Registered Radiology Assistant
A registered radiologist assistant (RRA) is an advanced-level radiologic technologist who works under the direct supervision of a radiologist to enhance patient care. Selected chapters of American Society of Radiologic Technologists (ASRT) are working with state radiological societies and the ACR on the radiologist assistant (RA) issue.
Thirty-one states license or recognize the RA. New Hampshire was added to that list this year following passage of SB 330. The ACR expects more radiologic technologist licensure bills to be introduced in upcoming 2017 legislative session.
Breast Health and Breast Density Disclosure
ACR staff has been actively engaged in collaborating with its state chapters, AMA state chapters and other specialty medical societies on issues related to breast density reporting. Since 2005, a total of 28 states (AL, AZ, CA, CT, DE, HI, IN, LA, MA, MD, MI, MN, MO, NC, ND, NJ, NY, NV, OH, OK, OR, PA, RI, SC, TN, TX, VA, VT) have adopted mandatory disclosure or breast density notification. In Utah, notification is suggested, and in Maine, radiologists have agreed to provide information without a legislative mandate.
In 2016, mandatory breast density reporting bills were pending in Florida, Georgia, Iowa, Kentucky, Mississippi, New Hampshire, Oklahoma, South Carolina, Vermont, Washington and West Virginia.
Washington State considered a bill to provide a sales and use tax exemption on digital breast tomosynthesis and for labor and services rendered in respect to installing, repairing, cleaning, altering, or improving digital breast tomosynthesis machines.
Notably, at the urging of the California Radiological Society, the California Department of Health Care Services dropped its brief support for screening mammography beginning at 50 in favor of annual screenings beginning at 40 for patients covered by Medi-Cal, the state’s low-income health insurance program.
Support for mandatory private insurance coverage of digital breast tomosynthesis (DBT) has increased along with the growing weight of evidence demonstrating its ability to detect breast cancer in patients with dense breast tissues. In 2016 California, Connecticut, Iowa, Maryland, and New Jersey considered legislation mandating DBT coverage.
Scope of Practice Issues
Non-physician medical personnel in several states looked to their legislatures for an expanded scope of practice that would allow them to operate X-ray equipment. In particular, registered nurses and nurse practitioners sought to expand the scope of their authorized medical privileges through a new designation of Advanced Practice Nurse Practitioners (APNRs). Recently, a Department of Veterans Administration (VA) proposal to allow advanced practice nurses at its health care facilities to practice without physician’s clinical oversight, regardless of individual state law, could seriously undermine the quality of care administered to the nation’s military veterans.
Medical Liability Legislation
Nearly all medical liability (malpractice) reform bills filed in 2016 died in committee. Bills related to medical liability reforms were introduced in more than 30 states.
Interstate Medical Licensure
Developed by the Federation of State Medical Boards (FSMB), the Interstate Medical Licensure Compact will make it easier for physicians to obtain licenses in multiple states while preserving individual state licensure requirements. Seventeen states now have laws to join an interstate compact and nine more have introduced legislation to speed up the licensure process. A state-by-state rundown of the status of the FSMB Interstate Medical Licensure Compact is covered in this interactive map.
State Legislation Tracking
The ACR established a collaboration with StateScape to offer comprehensive automated reports on legislative bills to state chapter leaders. The new vendor offers an ‘opt-in’ feature enabling ACR state affiliates to receive weekly e-mail reports during legislative session that keep them informed about the status of legislation in every state. Please let ACR staff know if you would like to opt in to receive optional legislative notifications for your state.
To assist preparations for 2017 legislative sessions, the ACR staff can help facilitate “guest caller” interaction during quarterly State Government Relations Committee discussions on various legislative issues affecting radiologists across the country. During the calls, ACR chapter members who have questions or are experiencing difficulties with state legislation can communicate with their colleagues to take away important feedback for their chapters’ strategy.
If you need further information on working with state legislators and how to get more involved in state legislative affairs with the ACR, please contact Eugenia Brandt, director of state affairs, via email or phone at 703-715-4398.