March 16, 2021

States Advance Breast Cancer Screening and Scope of Practice

Connecticut and Hawaii consider breast cancer screening coverage measures. Arkansas, Florida and Texas address legislation affecting supervision requirements for physician assistants (PAs) and advanced practice registered nurses (APRNs).

Breast Cancer Screening

In Connecticut, the Joint Committee on Insurance and Real Estate will hold a hearing on HB 6626. The bill would mandate carriers to cover diagnostic and screening mammograms for enrollees that are at least equal to the following minimum requirements:

  • A baseline mammogram, which may be provided by breast tomosynthesis at the option of the enrollee who is:
    • Thirty-five to thirty-nine years of age;
      • Younger than thirty-five years of age if the enrollee is believed to be at increased risk for breast cancer due to:
        • A family history of breast cancer; and
        • Positive genetic testing for the harmful variant of breast cancer gene one, breast cancer gene two or any other gene variant that materially increases the insured's risk for breast cancer.

In Hawaii, SB 827 passed the Committee on Commerce and Consumer Protection. It would expand coverage for breast cancer screening by low-dose mammography as follows:

  • For women age 35 to 39, including an annual baseline mammogram;
  • An annual mammogram for women age 30 to 50, deemed by a licensed physician or clinician to have an above-average risk for breast cancer; and
  • For women of any age, any additional or supplemental imaging, such as breast magnetic resonance imaging or ultrasound, deemed medically necessary by an applicable American College of Radiology® (ACR®) guideline.

Additionally, providers of healthcare services specified under this section would be reimbursed at rates accurately reflecting the resource costs specific to each modality, including any increased resource cost as of Jan. 1, 2021.

The bill would expand the definition of “low-dose mammography” to include both digital mammography and digital breast tomosynthesis and interpreting and rendering a report by a radiologist or other physician based on the screening. Digital breast tomosynthesis would be defined as: the means a radiologic procedure that allows a volumetric reconstruction of the whole breast from a finite number of low-dose two¬-dimensional projections obtained by different X-ray tube angles, creating a series of images forming a three-dimensional representation of the breast.

Scope of Practice

In Arkansas, HB 1258 passed the House and was referred to the Senate Committee on Public Health, Welfare, and Labor. The measure seeks to grant full independent practice authority to nurse practitioners (NPs) that complete 10,400 hours of practice under a collaborative practice agreement with a physician. It seeks to permit NPs to prescribe therapeutic devices appropriate to the NP’s area of practice.

In Florida, SB 894 will be discussed before the Health Policy Committee. It seeks to define an autonomous physician assistant as “a physician assistant who … could practice primary care without physician supervision.”

In Texas, SB 915 was introduced and referred to the Business and Commerce Committee. The measure seeks to permit APRNs to order, perform and interpret diagnostic tests.

Also in Texas, HB 4352 was filed in the House. The bill seeks to change the practice agreement between a PA and physician from supervising to a collaborating agreement, and permit PAs to interpret diagnostic studies and therapeutic procedures.

The Texas Radiological Society will be closely monitoring these proposed measures.

To stay abreast of state legislative developments relevant to radiology, view our policy map.