Legislatures hold hearings on measures including breast cancer screening, out-of-network billing and modifying scope of physical therapists. Utah’s governor signs bills modifying out-of-network billing provisions and physician assistant (PA) supervision requirements into law.
Breast cancer screening
In Arkansas, SB 290 passed both chambers. The bill would mandate carriers that cover breast cancer diagnostic exams to extend coverage to breast MRIs.
In Hawaii, SB 827 will be heard before the Committee on Commerce and Consumer Protection. It would expand coverage for breast cancer screening by low-dose mammography as follows:
- For women ages 35–39, including an annual baseline mammogram;
- An annual mammogram for women age 30–50, 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.
In Illinois, HB 3421 was assigned to the Health Care Licenses Committee. If a patient unknowingly receives care from a healthcare provider who is not in-network, the bill
would prohibit the healthcare provider from billing the patient for out-of-network care.
Utah’s Gov. Cox signed HB 54 into law. Carriers will be required to cover emergency healthcare services at the in-network rate.
In Tennessee, HB 2 would require the state insurance commissioner to establish an independent dispute resolution process to resolve disputes regarding bills for out-of-network emergency services. The commissioner would promulgate rules establishing standards for the independent dispute resolution process, including a process for certifying and selecting independent dispute resolution entities.
In determining the appropriate amount to pay for a healthcare service, an independent dispute resolution entity would not consider:
- Any benchmarking database that includes Medicare or Medicaid reimbursement rates; or
- Medicare or Medicaid reimbursement rates.
An out-of-network facility-based physician, healthcare facility or health carrier may submit a dispute regarding a fee or payment for emergency services for review to an independent dispute resolution entity. The independent dispute resolution entity would decide on a reasonable fee for the services rendered within 30 days of receipt of the dispute for review.
When determining a reasonable fee for the services rendered, the independent dispute resolution entity would select either the health carrier payment or the out-of-network facility-based physician's fee.
If an independent dispute resolution entity determines, based on the health carrier's payment and the out-of-network facility-based physician's fee, that a settlement between the health carrier and out-of-network facility-based physician is reasonably likely, or that both the health carrier's payment and the out-of-network facility-based physician's fee represent unreasonable extremes, then the independent dispute resolution entity may direct both parties to attempt a good faith negotiation for settlement. In that case, the health carrier and out-of-network physician may be granted up to 10 business days for negotiation, which runs concurrently with the thirty-day period for dispute resolution. An out-of-network facility-based physician may request, and the independent dispute resolution entity may permit, that claims of a physician involving the same health carrier be aggregated and submitted for simultaneous review by an independent dispute resolution entity when the specific reason for nonpayment of the claims aggregated involve a dispute regarding a common substantive question of fact or law.
If a balance bill is received by an enrollee for elective services does not assign benefits, or who is uninsured, then the enrollee may submit a dispute regarding the balance bill for review to an independent dispute resolution entity that shall determine a reasonable fee for the services rendered.
For disputes involving an enrollee:
- When the independent dispute resolution entity determines the health carrier's payment is reasonable, the out-of-network facility-based physician or healthcare facility would pay for arbitration; and if the entity determines the out-of-network facility-based physician's or healthcare facility's fee is reasonable, the carrier would pay for arbitration.
- When a good faith negotiation directed by the independent dispute resolution entity results in a settlement between the carrier and the out-of-network facility-based physician or healthcare facility, the carrier and the out-of-network facility-based physician or healthcare facility shall evenly divide and share the prorated cost of the dispute resolution.
The bill will be heard before the Insurance Subcommittee.
Scope of Practice
In Arkansas, HB 1258 passed both chambers. 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 Delaware, HB 33 passed House chamber. The bill seeks to change the practice agreement between a physician assistant and physician from supervising to a collaborating agreement. PAs would also be permitted to order therapeutic orders or procedures.
In Illinois, SB 1949 was referred to the Licensed Activities Committee. The bill seeks to permit advanced practice registered nurses licensed under the Nurse Practice Act to administer fluoroscopy without supervision.
In North Dakota, SB 2122 will be heard before the House Human Services Committee. The bill seeks to permit physical therapists to order musculoskeletal imaging consisting of plain film radiographs provided the physical therapist holds a clinical doctorate degree in physical therapy or has completed a board-approved formal medical imaging training program.
In Utah, Gov. Cox signed SB 27 into law. The bill changes the practice agreement between a PA and physician from a supervising to a collaborating agreement. The former provision permitting PAs to order, perform and interpret diagnostic studies and therapeutic procedures was dropped from the bill prior to it being signed into law.
Virginia’s Gov. Northam signed HB 2039 into law. The bill changes the practice agreement between a physician assistant and physician to a collaborative agreement. Additionally, the physician in the collaborative agreement would not be liable for the actions or inactions of the PA.
To stay abreast of state legislative developments relevant to radiology, view our policy map.