Prior Authorization, Scope of Practice Legislation Addressed in the States

The American College of Radiology® (ACR®) continues to monitor and track a wide variety of healthcare-related bills that have the potential to impact radiology. Below is an update on how some of these bills have fared this year.

Prior Authorization

Arkansas

House Bill (HB) 1271 would make the following changes regarding prior authorization:

• Requires that a utilization review entity must list all healthcare services that require prior authorization and any written clinical criteria.
• Mandates that when an adverse determination is issued that questions the medical necessity, the appropriateness or the experimental or investigational nature of a healthcare service; the utilization review entity must provide a physician (with the same or similar specialties as the requesting physician) to discuss the patient's treatment plan and the clinical basis for the intervention.
• Would permit a healthcare provider who received approval for 90% or more of the healthcare provider's prior authorization requests, for a particular healthcare service, then said provider would not be required to obtain prior authorization, for that particular service through Sept. 30, 2024.

This bill has passed both chambers and is currently awaiting action from Governor Sanders.

Nebraska

Legislative Bill 210 would mandate that by Jan. 1, 2025, each health carrier in the state must adopt a program that promotes modifications to its prior authorization requirements, and they must be based on the following:

• The performance of healthcare providers with respect to adherence to nationally recognized, evidence-based medical guidelines, appropriateness, efficiency and other quality criteria.
• An annual report that has re-examined the prescribing or ordering patterns of each participating provider.

A health carrier must report to the Department of Insurance aggregated trend data related to the health carrier’s prior authorization practices over a 12-month period. This would include things like the number of prior authorization requests received, the number of prior authorization requests that were denied, etc.

This bill has been referred to the Committee on Banking, Commerce, and Insurance.

North Dakota

Senate Bill (SB) 2389 creates a legislative management study of the prior authorization process for health insurance in North Dakota. This study among many things will look at the extent that prior authorization is used by health insurance companies and the administrative burden, time and cost associated with obtaining prior authorization.

This bill has been signed into law by Governor Doug Burgum.

Scope of Practice

Arizona

HB 2043 would eliminate the supervision agreement requirement for a physician assistant (PA) that has at least 8,000 hours of clinical practice. Instead, the PA would be required to collaborate with, consult or refer to the appropriate healthcare professional as indicated by the patient’s condition.

This bill has passed both chambers and is currently waiting for action from Governor Katie Hobbs.

New Mexico

HB 349 would have allowed an advanced practice registered nurse (APRN), nurse practitioner (NP), certified registered nurse anesthetist (CRNA) and clinical nurse specialist (CNS) to perform beyond their scope of practice of professional registered nursing and make independent healthcare decisions.

This bill failed to make it out of all its committees and the legislature has now adjourned sine die.

Oklahoma

HB 1709 would permit an advanced practice registered nurse (APRN) to serve as a primary care provider to as many as 2,500 Sooner Care patients. Sooner Care is Oklahoma’s Medicaid program.

This bill has been referred to the House Committee on Public Health.

Oregon

HB 2583 would change the term physician assistant to physician associate. A physician associate would still have to practice under a collaborative agreement with a physician.

This bill has been referred to the House Committee on Behavioral Health and Health Care.

West Virginia

SB 698 would change the title of a physician assistant (PA) to a physician associate. It would also change the relationship between a physician and a PA from supervisory to collaborative.

This bill failed to make it out of all its committees and the legislature has adjourned sine die.

The College 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. You can also access information and ACR resources 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 State Government Relations Specialist.