BILL NUMBER: S8290A

SPONSOR: MAY
 
TITLE OF BILL:

An act to authorize and direct the commissioner of health to establish a
portable diagnostics program

 
PURPOSE OR GENERAL IDEA OF BILL:

The purpose of this bill is to enhance accessibility to screening
services for Medicaid members, especially the elderly and disabled,
through the use of mobile medical imaging technologies, commonly known
as portable diagnostics.

 
SUMMARY OF SPECIFIC PROVISIONS:

The bill creates a new program that would expand and make permanent
coverage of portable diagnostic services for Medicaid members enrolled
in fee-for-service and Medicaid managed care. Rates of reimbursement and
setting locations would mirror those of the Medicare program.

              

Specifically, the commissioner of health is authorized and directed to:

*establish a portable diagnostics program that demonstrates the cost-ef-
fectiveness of medical assistance coverage of portable diagnostic
services, including X-rays, electrocardiograms, echocardiograms and
ultrasounds, provided to medical assistance recipients enrolled in both
fee-for-service Medicaid and Medicaid managed care. Such services shall
include those allowable and or provided by portable diagnostic providers
as authorized by title 42 of the code of federal regulations.

*reimburse portable diagnostics at the Medicare fee schedule by current
procedural terminology codes, transportation codes, and set-up codes.
Such rates of reimbursement shall apply to Medicaid recipients enrolled
in fee-for-service Medicaid, Medicaid managed care, and Medicaid managed
long-term care; and

*report to the legislature by December 31, 2024 on the cost-effective-
ness of the program. The report shall include a cost comparison of port-
able diagnostics, including X-rays, electrocardiograms, and ultrasounds,
provided in an authorized portable diagnostic setting compared to the
same procedure in a hospital, urgent care and emergency room setting.

**The amendment to this bill is a technical correction to the Title
number of the Federal law. It is amended to read Title XVIII.

 
JUSTIFICATION:

Portable diagnostics are cost-effective and offer safety and convenience
to both patients and providers by bringing mobile imaging directly to a
person, and avoiding costly hospitalizations. For example, effective use
of telemedicine, including tele-radiology in older adults, resulted in a
34% decrease in emergency room visits. The most common mobile imaging
services currently offered are X-ray, ultrasound, electrocardiograms,
and echocardiograms.  This program created by the bill will increase
access to and utilization of portable diagnostics for the frail, elderly
and disabled. Specifically, this bill will increase the Medicaid fee-
schedule to mirror Medicare, including all CPT codes for portable x-ray,
ultrasound, echocardiogram and EKG, including the Q-Code for setup and
an upstate/downstate blend for R-Code for transportation.  Additionally,
the bill expands settings to mirror Medicare, mandates health plans
(MC0s, MLTC) reimburse in accordance with Medicare, and recognizes that
the AMA & CMS set Medicare rates based on cost. As a result, there will
be lower costs to the Medicaid program through reductions in the unnec-
essary use of urgent care visits, emergency room visits, and hospital
stays.

Additionally, as the state continues to face the challenges of the
SARS-CoV-2 (Covid) pandemic, increasing the use of mobile imaging
services greatly reduces the risk of hospital-borne Covid infections for
the most vulnerable patients served.

 
LEGISLATIVE HISTORY:

New bill. S8290A (MAY)/A9298A (McDonald)

 
FISCAL IMPLICATIONS:

Significant savings to the state. Estimates range from $1 million to $10
million depending on the tests diverted from hospitals

 
EFFECTIVE DATE:
Immediately