Legislative Report: A Fast Start

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This year already has proven to be a busy one for legislative activity in radiology. The heightened level of interest has to do with several key factors. With the presidential election approaching in 2008, health care and its funding will continue to be a hot topic for debate; and as medical imaging costs and utilization continue to skyrocket, radiology will remain in the legislative and regulatory spotlight. Some early 2007 national and state highlights follow.

The National Front

HR 1293 is the latest version of the movement to roll back the Deficit Reduction Act (DRA) of 2005 imaging cuts. The American College of Radiology (ACR) has worked with the Access for Medical Imaging Coalition to introduce the legislation. The bill currently has 59 cosponsors. The DRA rollback will be the focus when radiologists lobby their congressmen during the ACR annual meeting in Washington on May 23.

The Mammography Quality Standards Act (MQSA) is also up for renewal. MQSA is subject to congressional reauthorization every 3-5 years. The process gives stakeholders the opportunity to propose new or updated measures to assure the quality and access of breast imaging for all women. Although a specific bill has yet to be introduced, several topics likely will be addressed in forthcoming proposals, according to Josh Cooper, the ACR's senior director, government relations. Among them is elimination of the exemption for stereotactic biopsy units, expansion of MQSA oversight to other modalities such as MRI and ultrasound, mandatory self-assessment as part of the minimum CME requirements, and Quality Control (QC) manual standardization for full-field digital mammography equipment.

Several cancer screening bills have been introduced. HR 1132 (S. 624) would reauthorize funding for the National Breast and Cervical Cancer Early Detection Program, which has subsidized mammography exams, Pap tests, and other screening methods since it was enacted in 1990. The bill would increase authorized funding and allow states to apply for federal waivers to spend more on some hard-to-reach women that advocates say have been underserved. HR 1738 and HR 1624 make appropriations for colon cancer screening and treatment. HR 1030 proposes funding for cancer screening specifically for minorities and/or underserved populations

The House and Senate have cleared the Trauma Care Coordination bill (HR 727+S657). The bill would authorize $46 million over five years in grants to help states further develop their trauma networks.

Also, in its 2008 budget resolution approved March 29, the House included reserves for reauthorization of the State Children's Health Insurance Program, Medicare changes, and federal health care fraud and abuse prevention programs. The budget still needs to be reconciled with the Senate version.

Stateside Activities

In my home state, the Arizona Radiological Society committed to initiate self-referral legislation. A lobbyist has been hired. SB 1559 would impose Stark-type restrictions on referrals for commercial beneficiaries. We succeeded in getting the bill sponsored by the Chair and Co-chair of the Senate Health Committee. Due to the pressure and support of key legislators, the Arizona Medical Society has pledged to work with the Arizona Radiological Society in finding ways to address egregious forms of self-referral.

After this legislative session, we are planning campaign functions for supporters of the bill and other potential sponsors. The ARS will also be developing presentations for regulators, politicians, administrators, and representatives of the payer community to raise awareness of self-referral schemes.

Other states continue to focus on self-referral, as well. Texas has submitted Senate Bill 1101 that would require disclosure with self-referral, described as "disclosure on steroids". The intent is to gather data and evaluate the true economic impact of self-referral to serve as a basis for future legislation. Another bill proposed would require that only the physician who renders the official interpretation could bill for the service. As in the 2007 proposed rules, the bill would eliminate the arbitrage of collecting global charges and then subcontracting for professional services at less than CMS rates.

Maryland, New Jersey, and Texas have all seen radiology assistant bills introduced.  As you may remember, the ACR and the American Society for Radiologic Technologists, Albuquerque, NM, published a joint statement supporting