March 28, 2019

States Legislatures Address Assortment of Imaging Issues

State legislators are advancing several bills concerning scope of practice for advanced practice registered nurses (APRNs) and physician assistants (PAs), mandates for breast density notification, solutions for out-of-network billing, and expanded coverage for breast tomosynthesis.

Scope of Practice

 In Illinois, SB1725 was recently referred to the Senate Licensed Activities Committee. The bill would allow physician assistants to “order, perform and interpret diagnostic studies and therapeutic procedures.” If enacted, PAs would also be allowed to supervise, delegate and assign therapeutic and diagnostic procedures to licensed or unlicensed personnel.

Introduced in January, SB 128, would direct the Oregon’s Board of Medical Imaging to issue permits that would allow qualified advanced practice registered nurses (APRNs) to supervise fluoroscopy. At a recent Senate committee hearing, the bill was amended to allow APRNS to supervise fluoroscopy under a physician’s supervision. The amendment also allows fluoroscopic X-ray equipment to be operated by a medical imaging licensee who specializes in radiography. The bill cleared the Senate and is scheduled for a first reading in the House.

Also introduced in Oregon in January, SB 62 would limit the practice of any medical imaging modality to medical imaging license holders and would prohibit employers from hiring non-licensed staff. The bill is scheduled for a hearing at the Senate Committee on Health Care.

Breast Density

 In the District of Columbia, B22-0960 passed into law. It requires health care facilities to provide patients receiving mammography exams with results including an identification of patients’ breast tissue classification. If a patient receives a class C or D breast density classification, the report would include the following notice:

“Your mammogram indicates that you have dense breast tissue. Dense breast tissue is relatively common and is not abnormal. Dense breast tissue can, however, make it more difficult to detect cancers in the breast by mammography because it can hide small abnormalities and may be associated with an increased risk for breast cancer. Accordingly, you may benefit from supplementary screening tests, which may include a breast ultrasound screening, or a breast MRI examination, or both, depending on your individual risk factors.

This information is given to you to raise your awareness. Use this information to talk to your health care provider about your own risks for breast cancer. At that time, ask your health care provider if additional screening and/or tests may be useful based on your own risk.

A report of your results was sent to your health care provider. You should contact your health care provider if you have any questions or concerns about this report.”

Out-of-Network Billing

 In Arkansas, SB 512 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. Introduced in March, the legislation recently cleared the Senate Committee on Insurance and Commerce.

In Colorado, HB 1174 passed the House chamber. The bill would require health insurance carriers, health care providers and health care facilities to inform enrollees about services by out-of-network providers and in-network and out-of-network facilities. The bill would establish the reimbursement amount for out-of-network providers that provide health care services to covered persons at an in-network facility and for out-of-network providers or facilities that provide emergency services to covered persons.

In Washington, HB 1065, which cleared the House chamber in early March, is scheduled for a hearing before the Senate Committee on Health & Long Term Care. The bill would require coverage billed at in-network rates for emergency services that screen and stabilize enrollees and would prohibit prior authorization. It would also prohibit balance billing directed to enrollees for elective services, including radiology, at in-network hospitals.

Cancer Screening

In Hawaii, HB 481 and its companion bill SB 1034, introduced in January, would expand health insurance coverage for breast tomosynthesis. The House version recently passed during a Senate committee hearing and was referred to the Ways and Means Committee. The Senate version passed following a House committee hearing and was referred to the House Finance Committee.

In Minnesota, SB 1038, introduced in February, would mandate coverage for a preventive mammogram screening, which would include digital breast tomosynthesis for enrollees at risk for breast cancer. Those identified “at risk” would include patients who have a family history of breast cancer, positive tests for BRCA1 or BRCA2 mutations, the presence of heterogeneously dense breasts, or extremely dense breasts based on the Breast Imaging Reporting and Data System established by the ACR, or a previous diagnosis of breast cancer. The bill is scheduled for hearings at the Senate Committees on Commerce and Consumer Protection and State Government Finance and Policy and Elections.

In New Hampshire, SB 58, which cleared the Senate chamber, was referred to the House Commerce and Consumer Affairs Committee. The bill would clarify reimbursement rates for low-dose mammography specific to each modality including any increased cost of breast tomosynthesis.