State legislation addressing major medical imaging concerns is moving forward, as more than half of the 50 state legislatures that were called into session earlier this year have finished their business or are scheduled to adjourn by the end of May.
The American College of Radiology has tracked incremental progress for bills relating to breast density, cancer screening, out-of-network billing and imaging scope of practice.
In Illinois, SB 1506 is scheduled for a second reading before the state House of Representatives. The bill would mandate mammography service providers to inform and notify patients if their mammogram demonstrates dense breast tissue. The mammography report would include a summary with language that may include, but not be limited to, the following information:
“Your mammogram shows that your breast tissue is dense. Dense breast tissue is very common and is not abnormal. However, dense breast tissue can make it harder to find cancer on a mammogram and may also be associated with an increased risk of breast cancer. This information about the result of your mammogram is given to you to raise your awareness. Use this information to talk to your doctor about your own risks for breast cancer. At that time, ask your doctor if more screening tests might be useful, based on your risk. A report of your results was sent to your physician."
In Connecticut, SB 838 passed the Senate Appropriations Committee. The bill would provide coverage for mammograms or digital breast tomosynthesis (DBT) for women ages 30 or older. The bills would also cover annual mammograms when recommended by a physician, if the patient has a family or personal history with breast cancer or if the patient has a prior history of breast disease. If enacted, additional provisions would provide coverage for ultrasound screenings if a mammogram demonstrates heterogeneous or dense breast tissue or if the patient is deemed to be at high risk for breast cancer.
In Illinois, SB 162 would expand coverage for a comprehensive ultrasound screening and diagnostic mammogram when medically necessary as determined by a physician licensed to practice medicine in all of its branches, advanced practice registered nurse or physician assistant. The bill had a second reading at the House chamber and added two senators as co-sponsors.
In New Hampshire, SB 58 is scheduled for an executive session in the House chamber. The bill would require that providers of low-dose mammography screenings be reimbursed at rates accurately reflecting the resource costs specific to each modality, including any increased cost of DBT.
In Texas, HB 170 is scheduled for a public hearing before the Senate Business and Commerce Committee. The bill would mandate health plans that cover mammography screenings also cover diagnostic mammograms.
In Missouri, SB 103 passed the House Committee on Rules - Administrative Oversight. The legislation would mandate health care providers to send claims for charges for emergency out-of-network services to the patient’s insurers within 180 days of the service. The bill also requires insurers to pay the provider a reasonable reimbursement within 45 days. If enacted, and the provider declines the insurer’s reimbursement offer, both parties would have 60 days to negotiate before facing an arbitration process. The arbitrator would then determine an amount between 120 percent of the Medicare reimbursement rate and 70th percentile of the usual and customary rate for emergency out-of-network services.
In Missouri, HB 756 passed the Senate Committee on Insurance Banking and is headed to the Senate floor. It would mandate health care providers to send any claim for out-of-network charges to the insurer within 180 days of out-of-network care. If enacted, reimbursements not agreed to between the two parties would require an arbitration process wherein the arbitrator would determine an amount between 120 percent of the Medicare allowed amount and 70th percentile of the usual and customary rate for unanticipated out-of-network care.
In Nevada, AB 469 has cleared both chambers and is awaiting the governor’s signature. The bill would prohibit an out-of-network provider from charging a person covered by health insurance for emergency services that exceeds the copayment, coinsurance or deductible required by that policy. The bill would also require an out-of-network facility that provides emergency services to a covered person to notify that individual’s insurer, and he or she is receiving services at the facility. The out-of-network facility is also required to transfer the covered person to an in-network facility no later than 24 hours after the person’s emergency medical condition has stabilized.
In Vermont, SB 31 has cleared both chambers. The bill would guarantee patients receiving outpatient surgical services or procedures at an ambulatory surgical center or hospital will be given an itemized, detailed and understandable explanation of charges with information about the center or hospital’s financial assistance and billing and collection practices.
Scope of Practice
In California, AB 890 would expand the scope of practice of nurse practitioners to include ordering and interpreting diagnostic procedures without physician supervision. It would also create an Advanced Practice Registered Nursing Board within the Department of Consumer Affairs. The bill is scheduled for a hearing before the Appropriations Committee.
In Maine, LD 1660 is scheduled for a hearing before the Joint Standing Committee on Health Coverage, Insurance and Financial Services. The bill would expand the scope of practice for physician assistants to include ordering, performing and diagnosing a diagnostic study or therapeutic treatment. The bill would also increase the Board of Licensure in Medicine from 10 to 11 members by adding a second physician assistant.
In Missouri, HB 705 would expand the scope of practice for physician assistants to include ordering tests, diagnostic laboratory and radiological services and therapies. The bill has passed an executive session held in the Senate.
In Ohio, HB 224 was referred to the House Health Committee. It would allow certified registered nurse anesthetists to order and evaluate diagnostic tests.
In Oregon, 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 under a physician’s supervision. The bill would also allow fluoroscopic X-ray equipment to be operated by a medical imaging licensee who specializes in radiography. The bill cleared both chambers and awaits the governor’s signature.
South Carolina’s Gov. Henry McMaster signed SB 132 into law. It will expand the scope of practice for physician assistants by allowing them to order diagnostic, therapeutic and other medical services under a supervising physician.
In Texas, HB 1504 has cleared both chambers. The bill would allow radiologist assistants to perform radiologic procedures under a radiologist’s supervision while prohibiting them from interpreting images or making diagnoses.