Texas expands breast cancer screening coverage while Nevada requires radiological technologists’ licensure to perform fluoroscopy. A New Jersey Senate committee passes a measure modifying out-of-network billing provisions.
Breast Cancer ScreeningTexas Gov. Greg Abbot signed Senate Bill (SB) 1065 into law. The law mandates carriers that cover screening mammograms also cover diagnostic imaging using mammography, ultrasound imaging or MRI. Diagnostic imaging will be used to evaluate:
- A subjective or objective abnormality in a breast detected by a physician or patient.
- An individual with a personal history of breast cancer or dense breast tissue.
The law takes effect Sept. 1.
The Texas Radiological Society (TRS) testified and actively advocated for this measure. This is the second session in a row that TRS has worked on this issue with success.
Radiological Technologist Licensure
Nevada Gov. Steve Sisolak signed radiological technologist licensure legislation (SB 455) into law. The law requires that fluoroscopy may only be performed within the licensee’s scope of practice if the licensee is certified by the American Registry of Radiologic Technologists in radiation therapy and has received sufficient training as approved by the Division of Public and Behavioral Health of the Department of Health and Human Services (Division). To perform computed tomography, the licensee must additionally be certified by the Nuclear Medicine Technology Certification Board to practice in nuclear medicine or radiation therapy and be trained by the Division.
The law took effect June 4.
In New Jersey, SB 3458 passed the Senate Commerce Committee. The bill would modify out-of-network provisions by permitting the arbitrator to determine a usual, reasonable and customary fee that would be one of the two amounts submitted by the parties in arbitration. To determine the fee, the out-of-network provider would submit the provider’s usual and customary fee by means of explanations of benefits from enrollees showing the provider’s billed and paid fee. The arbitrator would determine the reasonableness of the provider’s fee by comparison of the provider’s experience to providers in the area. When using a database as evidence of the reasonableness of a fee, the provider and carrier would both identify the database used, the edition date, the geo-zip, and the percentile. The arbitrator also would consider prior arbitration awards submitted by either party as evidence of reasonableness.
Scope of Practice
In Rhode Island, House Bill (HB) 5198 passed the House. Bill supporters seek to permit physical therapists to order diagnostic imaging, which they define as “basic radiological imaging.” Unless extended by the state general assembly, authorization for physical therapists to order diagnostic imaging would sunset Dec. 31, 2023.
The ACR and Rhode Island Radiological Society are monitoring the bill.