July 06, 2017

States Address Scope of Practice and Out-Of-Network Health Care

Several states are proceeding with bills concerning expanded scope of practice restrictions for advanced practice registered nurses (APRNs) and physician assistants as well as possible out-of-network billing solutions.

Scope of Practice

In Maine, Sen. Linda Sanborn introduced LD 1660 which 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 size of the Board of Licensure in Medicine from 10 to 11 members by adding a second physician assistant to the panel.

In Oregon, SB 128 would direct the Oregon’s Board of Medical Imaging to issue permits that would allow qualified 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 was recommended for House passage following a work session.

In South Carolina, SB 132 is scheduled for a hearing before the House Committee on Medical, Military, Public and Municipal Affairs. The bill would expand the scope of practice for physician assistants by allowing them to order diagnostic, therapeutic and other medical services with guidance from a supervising physician.

Out-of-Network Billing

In Colorado, HB 1174 passed in both chambers. 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 mandate out-of-network providers and facilities to be reimbursed at 105 percent of the carrier’s median in-network rate in the previous year for the same service performed in a similar geographic area as determined by claims data from the state’s all-payer health care claims database.

Also in Colorado, SB 134 died in the Senate Committee on Health & Human Services. For enrollees who receive emergency services at an out-of-network facility, the bill would have mandated that insurers reimburse the facility either the insurer’s average in-network rate, 125 percent of the Medicare reimbursement rate or 100 percent of the average in-network rate for the same service provided in a similar facility in the same geographic area for the prior year. It would have required an out-of-network provider in an in-network facility to inform the patient that they may obtain a list of in-network providers for an elective service.

In Louisiana, HB 371 is scheduled for a hearing before the House Insurance Committee. The bill would allow enrollees to request an independent dispute resolution for an out-of-network health benefit claim if the claim amount unpaid by the insurer is greater than $500 (after copayments, deductibles and coinsurance are applied). Enrollees would also be allowed to make the request if the health benefit claim is for emergency care or if the provider in a facility is a preferred provider.

In Missouri, SB 103 passed the House Insurance Policy Committee and was referred to 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 Washington, HB 1065 awaits the governor’s signature. 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 prohibit balance billing directed to enrollees for elective services, including radiology, at in-network hospitals.