June 12, 2019

States Advance Imaging and Out-of-Network Billing Legislation

Several bills progressed in legislative chambers or were signed into law in early June affecting breast tomosynthesis, cancer screening and out-of-network billing.

Breast Tomosynthesis
In Connecticut, SB 838 passed both legislative chambers. The bill would provide coverage for mammograms for women ages 35 to 39, which may include digital breast tomosynthesis (DBT). The bill would also cover annual mammograms when recommended by a physician, if the patient has a family or personal history with breast cancer, or if the patient has a prior history of breast disease. If enacted, additional provisions would provide coverage for ultrasound screenings if a mammogram demonstrates heterogeneous or dense breast tissue or if the patient is deemed to be at high risk for breast cancer.

Cancer Screening
Louisiana’s Gov. John Bel Edwards signed HB 347 into law. It will mandate coverage for diagnostic imaging at the same level of coverage provided for screening mammograms.

In New York, AB 5502 pass the Standing Codes Committee and was referred to the Ways and Means Committee. The Senate companion bill, SB 3852 was amended on its third reading in the Senate. Both bills would require coverage for annual mammography exams for covered persons aged 35 to 39, upon the recommendation of a physician.

Out-Of-Network Billing
In New York, AB 264 passed the Assembly chamber and was referred to the Senate. The bill would amend the 2014 Financial Services Law by allowing insurers to pay an amount it determines as reasonable for emergency services from an out-of-network provider, including for inpatient services after an emergency room visit.

An out-of-network provider or an insurer may submit a dispute regarding a fee or payment for emergency services to an independent arbitrator. In the event an insurer submits a dispute regarding a charge for an out-of-network hospital’s emergency services, the insurer would, after the initial payment, pay any additional amount it determines is reasonable directly to the hospital. The arbitrator would then make a determination within thirty days of receiving the dispute.

Vermont’s Gov. Phil Scott, signed SB 31 into law. It will guarantee that patients receiving outpatient surgical services or procedures at an ambulatory surgical center or hospital receive an itemized explanation of charges along with information about the center or hospital’s financial assistance and billing and collection practices.