Pending state health care legislation has implications for patient access to state-of-the-art breast imaging and breast density reporting, as well as protections against abusive physician self-referral. Here’s a summary compiled by the American College of Radiology, as we close out the first quarter of 2018:
State Insurance Coverage Mandates
In Washington State, Gov. Jay Inslee recently signed legislation that directs the state office of the insurance and the state health care authority to clarify that existing mammography mandates include insurance coverage for tomosynthesis under the same terms and conditions allowed for conventional X-ray mammography. In Vermont, lawmakers are considering a bill to ban cost-sharing for all breast imaging services.
Bills recognizing the clinical efficacy of digital breast tomosynthesis (DBT) and requiring insurers to cover it are also pending in Iowa, Louisiana, Massachusetts, Minnesota, New Hampshire, New York, Ohio, Oklahoma and Rhode Island.
States that mandate DBT insurance coverage now include Arizona, Connecticut, Illinois, Kentucky, Maryland, New Jersey, New York, Pennsylvania and Texas.
Breast Density Reporting
As of March 2018, 34 states are enforcing statutes on breast density reporting and disclosure. North Dakota’s statute was phased out in 2017. Governors of Florida and Washington signed breast density reporting bills into law (FL HB 735 and WA SB 8054), and a bill in Utah (HB 258) was signed into law this year to change the existing statute from optional to mandatory patient notification. Wisconsin’s bill has passed the House and Senate and is very likely to be signed into law shortly. Breast density reporting bills are still pending in Tennessee and Illinois, and a bill to extend the future sunset date for California’s breast density reporting statute has been filed.
The American College of Radiology is tracking three proposals seeking to restrict physician self-referral arrangements.
In Maryland, SB 1024 (HB 1519) would require the Maryland Health Care Commission to establish a process to exempt a specific oncology group practice in certain geographic regions from existing prohibitions against self-referral.
In Illinois, HB 1391 would amend the state Health Care Worker Self-Referral Act to stipulate that a health care worker shall not refer a patient to an entity outside the health care worker's office or group practice in which the health care worker is an investor unless that health care worker directly provides health services within the entity and will be personally involved with health care provided to the referred patient.
In Pennsylvania, HB 347 would prohibit health care provider self-referral and stipulates that a health care provider may not enter into an arrangement that the health care provider knows or should know has a principal purpose of assuring referrals of designated health services by a health care provider to a particular entity.