State Legislatures Consider Independent Practice Legislation

State legislatures continue to introduce legislation that could impact radiology and alter how healthcare is provided to their citizens.

Out-of-Network/Surprise/Balance Billing

Georgia

House Bill (HB) 70 would require a nonparticipating provider, before an emergency medical service, to notify the patient if such services will require $100 or more in out-of-pocket costs.

Senate Bill (SB) 20 creates the Consumer Access to Contracted Healthcare (CATCH) Act, which would make the following changes to consumer protections:

• An insurer providing a network plan shall contract with and maintain a network of providers in sufficient numbers and appropriate types, including primary care and specialty care, pharmacies, clinical laboratories, and facilities.
• If there is not a specialty care provider, needed for a specific condition, included in the insurance plan's list of participating specialty care providers (in-network), then that patient would have access to nonparticipating healthcare providers (out-of-network).
• The Georgia Insurance Commissioner will determine network adequacy and may use the following appropriate criteria, including, but not limited to:
  • Primary care provider to covered person ratios.
  • Provider to covered person ratios by specialty.
  • Geographic accessibility of providers.
  • Access to healthcare services through telehealth or telemedicine.

• An insurer shall not deny preauthorization for healthcare services to be performed by a participating provider solely because the covered person's referral to such provider was made by a nonparticipating provider.

New York

Assembly Bill 2663 would require insurance companies to notify patients before a procedure, test or surgery, that an out-of-network physician may be used in such a service. This bill would also require the patient’s insurance carrier to cover the incurred, out-of-network fee if the patient was not notified beforehand.

Scope of Practice

Arkansas

SB 112 would require that a physician assistant (PA) be identified as the treating provider in the billing and claims process when the PA delivered the medical services to the patient.

Colorado

SB 23-083 would modify the relationship between a PA and a physician by removing the requirement that a PA be supervised by a physician and replacing it with a collaborative agreement. Some of the items that a collaborative agreement must include are the following:

• The signature of the physician assistant and the person with whom the physician assistant has entered into the collaborative agreement.
• A general description of the physician assistant's process for collaboration.
• A description of the performance evaluation process of the PA.
• For a PA with fewer than 3,000 practice hours the collaborative agreement would also require that collaboration during the first 160 practice hours be completed in person or through technology.

Florida

HB 481 would allow a PA to procure medical devices and drugs, and prescribe or dispense any medication used in the physician’s practice independent of physician supervision. This bill would also require a PA to complete a minimum of 10 continuing medical education hours in the specialty practice in which the physician assistant has prescriptive privileges.

Montana

HB 313 would provide for the full independent practice of PAs.

Ohio

SB 28 would enjoin Ohio into the Physician Assistant Licensure Compact. This compact allows PAs who meet its eligibility requirements to practice in other compact states.

Washington

HB 1495 would require health insurance plans to reimburse advanced registered nurse practitioner PAs at the same amount, for the same service, as it would a physician.

Telemedicine

In Hawaii, HB 907 would mandate that reimbursement for services provided through telehealth via an interactive telecommunication system should be equivalent to reimbursement for the same services provided via face-to-face contact between a healthcare provider and a patient.

The American College of Radiology® (ACR®) has partnered with Fiscal Note, a legislation and regulation tracking service, to provide continuous, comprehensive updates on radiology and healthcare-related legislation. To stay current on state legislative developments relevant to radiology, view the ACR policy map.

For more information about state legislative activities, please contact Eugenia Brandt, ACR Senior Government Affairs Director, or Dillon Harp, ACR Senior Government Relations Specialist.