Breast Density Bill Passes Senate

Sen. Simitian (D-San Jose) SB 1538 passed the full Senate on Tuesday on a vote of 39-0. It will now move through the Assembly. The bill is nearly identical to his SB 791 from last year that was vetoed by Governor Brown. The bill requires that women determined to have dense breast tissue during screening mammography be given specific information in their MQSA letter regarding the risks of dense breast tissue, possible benefits of other screening procedures, and that they should discuss this with their physician. During his presentation on the floor Sen. Simitian indicated that he continues to refine the specific wording of the notice in an effort to resolve the concerns of the Governor. The CRS has a neutral position on the bill and continues to work to refine the specifics of the notice content to women with dense breast tissue.

Medi-Cal Radiology Rate Reduction 

In 2010 the state budget included a provision that would have required the Medi-Cal program to reimburse radiology services under Medi-Cal at no more than 80 % of the comparable Medicare allowable. This change slated to be effective as of 10/1/10 would have had a dramatic impact on reimbursement for MRI, CT and PET services and would not have resulted in procedures paid far less than 80% of Medicare to be brought up to that level, i.e. plain films and ultrasound. The CRS retained outside counsel and was prepared to file for injunctive relief if the cuts were implemented.

To date the reductions have not occurred and the request by California to change this element of their state Medicaid plan via a SPA ( state plan amendment) has never been approved by CMS. Last week during the review of the 2012-13 state budget there was consideration of implementation via an update by DHCS. DHCS had indicated that they would implement this reduction in September of 2012, but the Senate Budget Sub-Committee required them to implement as of July 1, 2012 in an effort to score more savings in the fiscal year beginning July 1, 2012.  The CRS is reviewing this development with outside counsel. The 2012-13 state budget has not yet been adopted but will likely occur in June. It is not likely that DHCS could implement that quickly and we have not seen evidence that CMS is going to issue approval of the SPA. We will keep you informed as we learn more about their likely action.

Bill on RT Injection of Contrast Material

The CRS sponsored SB 1199 (Dutton) regarding the training and scope of practice for RTs to inject contrast material. Existing law allow an RT to inject contrast material into an upper extremity provided they obtain certain training.

That training includes performing 10 venipunctures. Last year the RHB sent a letter to all RT schools indicating that those 10 venipunctures must be performed on humans. That is an issue for some schools who might use phantom simulators due to liability concerns or shortage of humans for this purpose.

SB 1199 originally would have made two changes (1) to specify that training including performing 10 venipunctures can be done on a human or phantom simulator, and (2) that the RT could be allowed to administer other substances to insure the patency of the IV cannula according to hospital or imaging facility protocol. The latter provision would clarify that injection of a saline solution to flush the line would be specifically permitted.