June 06, 2019

States Push Forward with High-Priority Imaging Legislation

Progress was again reported in the final week of May in several states for imaging-related legislation affecting cancer screening, out-of-network billing, breast density reporting and scope of practice limits.

Cancer Screening

In Illinois, SB 162 cleared both legislative chambers. The bill would expand coverage for a comprehensive ultrasound screening and diagnostic mammogram when medically necessary as determined by a physician licensed to practice medicine in all of its branches, an advanced practice registered nurse or physician assistant.

In New York, AB 5502 is scheduled for a hearing before the Standing Codes Committee. It 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 California, AB 1611 cleared the House chamber and was referred to the Senate Rules Committee. The bill would prohibit enrollees from paying more to an out-of-network provider than an in-network provider for the same covered services.

The bill would also require the insurer to pay an out-of-network provider for emergency services rendered pursuant to a specified formula. It would require the provider to bill, collect and make refunds in a specified manner and would provide a dispute resolution procedure, if any party is dissatisfied with payment. Reimbursements for out-of-network providers would be based on the reasonable and customary value of the hospital services or the average contracted rate on a fee-for-service basis for the same or similar hospital services in the general geographic region in which the services were rendered.

Breast Density

In Illinois, SB 1506 cleared both chambers. The bill would mandate mammography service providers to inform and notify patients if their mammogram demonstrates dense breast tissue. The mammography report would include a summary with language that may include, but not be limited to, the following information:

“Your mammogram shows that your breast tissue is dense. Dense breast tissue is very common and is not abnormal. However, dense breast tissue can make it harder to find cancer on a mammogram and may also be associated with an increased risk of breast cancer. This information about the result of your mammogram is given to you to raise your awareness. Use this information to talk to your doctor about your own risks for breast cancer. At that time, ask your doctor if more screening tests might be useful, based on your risk. A report of your results was sent to your physician."

Scope of Practice

In Texas, HB 1504 was sent Gov. Greg Abbott and awaits his signature. The bill would allow radiologist assistants (RAs) to perform radiologic procedures under a radiologist’s supervision but prohibits RAs from interpreting images or making diagnoses.