Legislation relevant to radiologists and their patients — ranging from prior authorization to scope of practice — continues to wend its way through state legislatures. The American College of Radiology® (ACR®) state government relations team is busy tracking these bills and provides the following update. Of note this week are bills related to network adequacy, prior authorization and scope of practice.
Senate Bill (SB) 1359 would require the issuer of health benefit plans in Texas to submit an annual report to the Texas Department of Insurance (TDI) regarding whether participating providers issued or provided services in person in the area in which the patient resided, or through the use of telemedicine.
SB 2622 would make the following changes regarding prior authorization:
- A health insurance issuer shall make any current prior authorization requirements and restrictions easily accessible and posted on its website.
- If a health insurance issuer intends either to implement a new prior authorization requirement or restriction, or amend an existing requirement or restriction, the issuer must provide contracted healthcare professionals written notice of the new or amended requirement or amendment no less than 60 days before the requirement or restriction is implemented.
- A health insurance issuer must ensure that all adverse determinations are made by a physician when the request is by a physician.
House Bill (HB) 1045 states that a health carrier or utilization review entity shall not require a healthcare provider to obtain prior authorization for a service if the provider has been approved 90% of the time for that specific service.
Assembly Bill 1255 and SB 1794 would make the following changes to a utilization review entity:
- A utilization review entity shall ensure that all adverse determinations are made by a physician.
- If a utilization review entity is questioning the medical necessity of an enrollee’s healthcare service, the entity must notify the physician of the enrollee.
- Before issuing an adverse determination, the physician of an enrollee must have the opportunity to discuss the medical necessity of the healthcare service by phone with the physician who will be responsible for determining authorization.
This bill defines a utilization review entity as any individual or entity that performs prior authorizations.
Scope of Practice
SB 112 would allow direct billing and payment of physician assistants (PAs) and require that they be identified as the treating provider.
Senate File 2394 would enjoin Minnesota into the PA Licensure Compact. This compact allows PAs who meet its eligibility requirements to practice in other compact states.
The governor’s fiscal year 2023 budget would make the following changes regarding the scope of practice for PAs:
- Remove physician supervision for PAs who have practiced for more than 8,000 hours and are practicing in primary care and certain non-surgical specialties or in a health system or hospital that has given them privileges.
- Permit PAs to prescribe, dispense, administer or procure items necessary to commence or complete a course of therapy.
- Remove the physician-to-PA supervision ratio.
SB 408 would direct the Oregon Health Authority to establish a process to receive and review healthcare profession scope of practice requests and impact statements. This bill defines scope of practice requests as a written request to establish or revise the scope of practice for a healthcare profession and an impact statement as a written statement that describes the impact that the establishment or revision of a scope of practice may have on the healthcare provider that is the subject of the scope of practice request.
HB 3227 would prohibit a physician from supervising or delegating the prescribing or ordering of a drug or device to a PA or advanced practice registered nurse (APRN) if the physician has, in the preceding two years, been subject to disciplinary action for a standard of care violation by the Texas Medical Board or a medical licensing board of any other state.
HB 3228 would require that a physician who supervises or delegates medical acts to any non-physician healthcare provider to attest on their registration renewal application that they have provided proper supervision and have properly delegated medical acts.
SB 584 would allow a physical therapist to treat a patient for 30 consecutive days without obtaining a referral from a referring practitioner.
HB 1310 would remove the requirement that PAs work under the supervision of physicians. Instead, PAs would be allowed to work under collaboration agreements.
The governor’s 2023–2025 budget includes language that would allow an APRN to practice independently after completing 3,840 hours of professional nursing in a clinical setting and 3,840 clinical hours while working with a physician or dentist.
The College has partnered with Fiscal Note, a legislation and regulation tracking service, to provide continuous, comprehensive updates on radiology and healthcare-related legislation. To stay current on state legislative developments relevant to radiology, view the ACR policy map. You can also access information and ACR resources about scope of practice.
For more information about state legislative activities or if you need any guidance on legislation in your state, contact Eugenia Brandt, ACR Senior Government Affairs Director, or Dillon Harp, ACR Senior Government Relations Specialist.