As some state legislative sessions are starting to wind down, others are still in full force. This week, the American College of Radiology® (ACR®) state government relations team is seeing prior authorization, scope of practice and telehealth bills being considered by the states.
Senate Bill (SB) 143 would make the following changes regarding prior authorization:
- A utilization review entity would be required to list any healthcare services that require prior authorizations.
- Before an adverse determination is issued by a utilization review entity, the utilization review entity would be required to provide the healthcare provider a reasonable opportunity to discuss with a physician the patient's treatment plan and the clinical basis for the utilization review entity's determination.
- Would exempt a provider from having to obtain prior authorization for a particular healthcare service if the healthcare insurer has approved or would have approved that healthcare service at least 90% of the time.
Legislative Bill 210 would make the following changes regarding prior authorization transparency:
- By Jan. 1, 2025, each healthcare carrier would be required to list the performance of healthcare providers concerning adherence to nationally recognized, evidence-based medical guidelines, appropriateness, efficiency, and other quality criteria.
- By June 1, 2024, each healthcare carrier would be required to report: the number of prior authorization requests, the number of prior authorization requests denied, the number of appeals received, the number of adverse determinations reversed on appeal, the ten individual services most frequently denied and the ten reasons most frequently used to deny prior authorization requests.
Scope of Practice
SB 5520 would allow a physician assistant (PA) who has completed 3,600 of training to practice without physician supervision.
SB 458 would permit an advanced practice registered nurse (APRN) who has completed 6,240 hours of practice with prescriptive authority supervised by a physician or a supervising APRN to apply for the authority to prescribe and order independent of supervision.
House Bill 4071 would allow an advanced practice registered nurse (APRN) to practice independently if the APRN has met one of the following requirements:
- Holds a nationally recognized board certification in psychiatric or mental health nursing.
- Practices in a rural county.
- Practices serving a medically underserved population.
SB 1700 would provide for the independent practice of an advanced practice registered nurse (APRN). This includes the ability to order, perform and interpret diagnostic tests.
SB 1959 would prohibit a physician to supervise or delegate the prescribing or ordering of a drug or device to a physician assistant (PA) or advanced practice registered nurse (APRN) who practices in a medical specialty outside the scope of the physician's residency training or primary medical practice, unless the physician has at least five years of practice experience in that specialty.
Assembly Bill 276 would permit a healthcare provider, who is located at an originating site and is conducting a forensic medical examination of an apparent victim of sexual assault or strangulation, to use telehealth to connect to an appropriately trained physician, physician assistant (PA) or registered nurse (RN) who is located at a distant site for the purpose of obtaining instructions and guidance on conducting the examination. This bill would also clarify that “telehealth” includes communication between a healthcare provider who is providing in-person services to a patient and another healthcare provider at a different location.
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.