The American College of Radiology® (ACR®) state government relations team has been tracking a plethora of prior authorization and scope of practice bills throughout 2023, and below is an update about how some of these bills have faired during this legislative cycle.
District of Columbia
Bill 25-0124 would make the following changes regarding prior authorization:
• When a prior authorization is granted or denied, the notification must be made within 24 hours of the determination.
• Adverse determinations must include grounds for denial and appeals information.
• Prior authorizations shall be valid for one year, with the exception that prior authorizations for long-term or chronic conditions last for the length of the treatment.
• Adverse determinations must be made by a physician licensed in DC and of the same specialty.
Finally, and perhaps most importantly, the bill would prohibit insurers from requiring prior authorization for a treatment based solely on cost.
Currently this bill has been re-referred to the Committee on Health and is awaiting action.
SB 2622 would have made 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.
This bill passed both chambers but was recently vetoed by Governor Tate Reeves.
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.
This bill has been referred to the House General Laws Committee.
Scope of Practice
HB 5481 would eliminate mandatory physician oversight of a physician assistant.
The bill has been referred to the Joint Public Health Committee.
SSB 1046 (SF 211) and HSB 11 (HSF 174) would permit the referral of a patient by a physical therapist for diagnostic imaging, including plain radiographs and magnetic resonance imaging, provided the results of the imaging are evaluated by a healthcare provider that is qualified and permitted to interpret the results.
Currently both bills have been approved by their respective committees and are awaiting further action in both chambers.
SB 2126 would allow a PA to engage in the use of fluoroscopy for guidance of diagnostic and therapeutic procedures, provided that the PA has successfully completed an educational program consisting of at least 40 hours of didactic and 40 hours of clinical training with successful completion of a competency exam.
Currently this bill has been referred to the Senate Health Committee.
HB 5013 would extend a sunset provision to allow physical therapists to order diagnostic imaging until Dec. 31, 2025.
The bill was heard in the House Health and Human Services Committee. The committee recommended it be held for further study.
HB 1388 and SB 1191 would eliminate the Radiologic Imaging and Radiation Therapy Board of Examiners and would move the licensing of all persons performing radiologic imaging, radiography or radiation therapy procedures in hospitals, outpatient diagnostic centers, recuperation centers, physicians’ offices, or any other settings to the Tennessee Department of Health Division of Health-Related Boards.
HB 1388 is in the House Committee on Government Operations, and SB 1191 is in the Senate Committee on Government Operations.
SB 5373 would require health insurance plans to reimburse advanced registered nurse practitioners and physician assistants at the same rates as a physician when the same service is provided.
Currently this bill passed the Senate Health and Long-Term Care Committee and was referred to the Senate Ways and Means Committee where it is awaiting consideration.
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.