State Legislatures Continue to Debate Legislation Ranging From Network Adequacy to TIA

While some state legislative sessions are winding down, scope expansion bills failed in multiple states, including major scope of practice (SOP) wins in Mississippi and South Dakota.

Network Adequacy

Illinois

House Bill (HB) 4025 would require the Illinois Department of Insurance to create a network adequacy unit. The unit would be tasked with investigating insurers' compliance with Illinois’s 2017 Network Adequacy and Transparency Act.

The Illinois Radiological Society is monitoring this bill.

Out-of-Network/Surprise/Balance Billing Bills

Minnesota

Senate File 3021 would create the Minnesota Health Plan (MHP). Details of this health plan include:

• Coverage of all healthcare services except:
  • Services that are determined to have no medical benefit by the MHP board.
  • Treatments and procedures that are primarily for cosmetic purposes, unless such a service is deemed medically necessary by a licensed healthcare provider in the MHP.
  • Any healthcare service that is not licensed or accredited by the state.
• The MHP would not pay for drugs requiring a prescription if the pharmaceutical companies directly market those drugs to consumers in Minnesota.
• The MHP will be funded by enrollee premiums, federal funding and the state’s Health Care Access Fund (HCAF).
• The MHP would set annual budgets for in-network providers; these budgets would cover anticipated healthcare services for the next year based on past performance and projected changes in prices and healthcare service levels.
• An Ombudsman Office for Patient Advocacy would be created.

Scope of Practice

Nevada

Assembly Bill 364 would remove physician supervision of a physician assistant (PA) after the PA has completed 4,000 hours of practice under a collaborative agreement with a physician.

North Carolina

Senate Bill (SB) 324 would enjoin the state of North Carolina into the Interstate Medical Licensure Compact. This compact allows physicians who meet the compact’s eligibility requirements to practice medicine in other compact states.

Vermont

HB 473 would make the following changes regarding radiologist assistants (RAs) and radiologists:

• If a supervising radiologist is not physically present at the location where a RA is practicing, the RA shall provide services only when a licensed physician — who does not have to be a radiologist — is physically present and would be responsible for providing intervention or assistance in the event of a medical emergency.
• An RA would be strictly prohibited from interpreting images, making diagnoses, or prescribing medication or therapies, but may communicate with patients regarding the RA’s preliminary observations regarding the technical performance of a procedure or examination and regarding the findings from a radiologist’s report. Preliminary observations shall not include any communication about the presence or absence of features or characteristics that would be considered in making a diagnosis.

Truth in Advertising

Georgia

SB 197 would make the following changes regarding truth in advertising (TIA):

• Communications or statements by a healthcare practitioner must include the practitioner's name and the type of license to provide services.
• Communications or statements by a healthcare practitioner that include misleading terms or false representations are prohibited.
• Advanced practice registered nurses (APRN) and PAs must verbally identify themselves during each patient interaction in a clinical setting.
• If an APRN or PA holds a doctorate degree and identifies themselves with the title doctor in a clinical setting, they must clearly state that they are not a medical doctor or physician.

The Georgia Radiological Society supports this bill.

The American College of Radiology® (ACR®) has partnered with Fiscal Note, a legislation and regulation tracking service, to provide continuous, comprehensive updates about radiology and healthcare-related legislation. To stay current regarding state legislative developments relevant to radiology, view the ACR policy map. You can also access information and ACR resources there about scope of practice.

For more information about state legislative activities or if you need any guidance on legislation in your state, contact Eugenia Brandt, ACR Senior Government Affairs Director, or Dillon Harp, ACR Senior Government Relations Specialist.