Several states consider and advance breast cancer screening legislation. Kentucky and Utah address bills that modify out-of-network billing provisions. Virginia’s state legislature passes a bill affecting supervision requirements for physician assistants (PAs).
Breast Cancer Screening
In Arkansas, SB 290 passed the Senate chamber. The bill would mandate carriers that cover breast cancer diagnostic exams to extend coverage to breast MRIs.
In Hawaii, SB 827 passed the Committee on Commerce and Consumer Protection. It would expand coverage for breast cancer screening by low-dose mammography as follows:
- For women aged 35 to 39, including an annual baseline mammogram;
- An annual mammogram for women over age 30, deemed by a licensed physician or clinician to have an above-average risk for breast cancer; and
- For women of any age, any additional or supplemental imaging, such as breast magnetic resonance imaging or ultrasound, deemed medically necessary by an applicable American College of Radiology® (ACR®) guideline.
Additionally, providers of healthcare services specified under this section would be reimbursed at rates accurately reflecting the resource costs specific to each modality, including any increased resource cost as of Jan. 1, 2021.
The bill would expand the definition of “low-dose mammography” to include both digital mammography and digital breast tomosynthesis, and interpreting and rendering a report by a radiologist or other physician based on the screening. Digital breast tomosynthesis would be defined as: the means a radiologic procedure that allows a volumetric reconstruction of the whole breast from a finite number of low-dose two¬-dimensional projections obtained by different X-ray tube angles, creating a series of images forming a three-dimensional representation of the breast.
In Rhode Island, HB 6019 was introduced and referred to the House Health and Human Services Committee. It would require insurance carriers, nonprofit hospital service plans, nonprofit medical service corporations and health maintenance organizations to cover breast ultrasounds and/or MRI breast exams for any person receiving a dense breast tissue notice.
In West Virginia, HB 2663 was introduced and referred to the Banking and Insurance Committee. The bill would mandate carriers that cover laboratory or X-ray services cover the following healthcare services:
- One baseline mammogram examination for women aged 30–40 years of age; a mammogram examination every year for women aged 40 and over; and, in the case of a woman who is under 40 years of age and has a family history of breast cancer or other breast cancer risk factors, a mammogram examination at such age and intervals as deemed medically necessary by the healthcare provider; and
- A comprehensive ultrasound screening of an entire breast or breasts if a mammogram demonstrates heterogeneous or dense breast tissue based on the Breast Imaging Reporting and Data System established by the ACR or if a woman is believed to be at increased risk for breast cancer due to family history or prior personal history of breast cancer, positive genetic testing, or other indications as determined by a woman’s physician or advanced practice nurse.
The bill would also require the radiologist or mammography facility to include in the mammography summary information that identifies a patient’s breast density. This information shall be based upon the Breast Imaging Reporting and Data System established by the ACR.
The information included would:
- State that high-density breast tissue is not abnormal;
- Provide detail of the potential risks from high breast density;
- Provide information on the benefits of additional screening; and
- Suggest that the patient speak with the patient’s primary care physician.
Out-Of-Network Billing
In Kentucky, SB 19 was referred to the Banking and Insurance Committee. The bill would require carriers to reimburse the out-of-network providers the greater of the following:
- The insurer's median in-network rate for the current year; or
- The insurer's median in-network rate for the year 2019.
Carriers would send a notice to the out-of-network provider of any cost sharing owed for the emergency out-of-network care. The amount of cost sharing owed would:
- Not exceed the in-network rate; and
- Be calculated based on the median in-network rate for a healthcare service in a similar geographic region using a database or other source information determined appropriate by the state insurance commissioner.
The bill would also require the commissioner to establish and administer an independent dispute resolution program and specify a nonprofit organization that maintains a database of billed charges submitted by providers for healthcare services to be used as a benchmark for determining the usual and customary rate.
In Utah, HB 54 passed the Business and Labor Committee. It would require carriers to cover emergency healthcare services at the in-network rate.
Scope of Practice
In Arkansas, HB 1258 will be heard before the Committee on Public Health, Welfare, and Labor. The measure seeks to grant full independent practice authority to nurse practitioners (NPs) that complete 10,400 hours of practice under a collaborative practice agreement with a physician. It seeks to permit NPs to prescribe therapeutic devices appropriate to the NP’s area of practice.
In Utah, SB 27 passed the House Business and Labor Committee and had its second reading in the House chamber. The bill seeks to change the practice agreement between a PA and physician from a supervising to a collaborating agreement. The measure seeks to permit PAs to order, perform and interpret diagnostic studies and therapeutic procedures. The Utah Radiological Society is closely tracking the development of this measure. The Society is in the process of educating the committee members to clarify that PAs may order diagnostic procedures and, specifically for radiologic procedures, utilize the findings or results in treating the patient.
In Virginia, HB 2039 passed the House and Senate chambers. The measure seeks to change the practice agreement between a physician assistant and physician to a collaborative agreement. Additionally, the physician in the collaborative agreement would not be liable for the actions or inactions of the PA.