March 14, 2019

State Legislators Address High Priority Imaging Issues

State legislators across the country are making significant progress on bills addressing mandates for breast density notification, imaging-related scope of practice for advanced practice registered nurses (APRNs) and solutions for out-of-network (OON) billing.

Breast Density

Breast density notification legislation made significant progress this session in New Mexico, South Dakota and Georgia to potentially add them to the 37 states that have already passed laws to require a mandate.

The following bills all would require health care facilities to inform patients when their mammography reveals the presence of dense breast tissue. In New Mexico, Gov. Michelle Lujan Grisham signed into law, HB 66, and in South Dakota, Gov. Kristi Noem signed into law HB 1124. In Georgia, HB 62 passed both chambers and now awaits the governor’s signature.

Scope of Practice

In Texas, opposing bills have been introduced to address the appropriate scope of practice for APRNs and their involvement with radiological procedures. Rep. Drew Darby introduced HB 2907, a bill that would allow physicians to delegate authority for APRNs to read and interpret radiological studies and render diagnoses based on radiological studies. Rep. J.D. Sheffield responded with HB 4312. It would prohibit physicians from delegating authority for reading, interpreting or rendering a diagnosis from a radiological study.

Out-of-Network Billing

Several states introduced bills to address out-of-network (OON) billing. In Arkansas, Sen. Cecil Bledsoe, vice chair of the Insurance & Commerce Committee, introduced SB 512, a bill that would guarantee patients the right to receive reimbursement for any health care service regardless of whether the health care provider is in- or out-of-network.

In Florida, Rep. Colleen Burton introduced HB 1317, a bill that would require a standard of 200 percent of the participating physician's fee schedule of Medicare Part B for emergency services and 200 percent of the fee schedule of Medicare Part A for non-emergency services.

In Georgia, HB 84 did not secure enough votes to pass the state House of Representatives. It would have required patients to find out which doctors involved with their upcoming procedure are in-network and would establish a mediation process to address disputed bills. In contrast, SB 56, unanimously passed the Senate chamber, would go further than the house bill by establishing a database of prices the patient’s insurance company must pay, rather than leaving the patient to responsible for whatever the out-of-network doctor charges. Reimbursement would be set to a minimum benefit standard of the 95th percentile of allowable benefits and the 80th percentile of charges averaged together for a particular medical service performed by a health care provider in a similar specialty and provided in the same geographic area.

In Minnesota, Rep. Steve Elkins introduced HB 2300. The bill would require health plan companies to develop and implement a shared savings incentive program for patients. It would also mandate the insurance commissioner to develop an online system where consumers can compare average provider charges for health care services by procedure.

Texas’ Rep. Carl Sherman introduced HB 3828, legislation that would require physicians to inform patients when they schedule another healthcare practitioner to treat the patient for an elective service. The disclosure statement would state that the scheduled practitioner may not be in the patient’s provider network.

In Virginia, both chambers passed HB 2538. The bill would require health care facilities to determine if providers scheduled to deliver elective services are in the patient’s managed care network. If the provider is out-of-network, the facility would be obligated to inform the patient of the out-of-network status, provide them with the opportunity to be referred to an in-network provider. The facility would also have to prepare a document for the patient’s signature to indicate that she or he assumes financial responsibility for services performed by the out-of-network provider. The bill now awaits the governor’s signature.