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Update on MARCA

The Medicare Access to Radiology Care Act (MARCA) of 2017 was introduced on March 29 by U.S. Senator John Boozman (R-AR) as S. 769 and on April 5 by Representative Pete Olson (R-TX) as H.R. 1904. These bills propose a law that amends Medicare reimbursement policy and supervision levels for radiologist assistants to align them with state radiologist assistant laws.

The Centers for Medicaid and Medicare Services announced in its Medicare Physician Fee Schedule Final Rule that radiologist assistants and radiology practitioner assistants can practice with reduced radiologist supervision requirements. The positive change follows significant advocacy with CMS by ASRT and other radiology stakeholders.

Under the new provision, RAs and RPAs, advanced-level radiographers who perform radiologic assessments and certain exams traditionally performed by radiologists, can perform diagnostic exams under "direct" supervision. This means a radiologist does not need to be present in the room where the exam is taking place; however the radiologist must be in the facility and immediately available to render assistance.

"This is a huge win for patients, RAs and the entire profession. RAs can now practice with fewer restrictions so radiologists can focus on interpreting urgent cases and performing exams that are more complex," said ASRT President Melissa Jackowski, Ed.D., R.T.(R)(M), FASRT.
The rule directs Medicare to follow the supervision levels and scope of practice regulations specified in state RA and RPA licensure laws and standards. The majority of states require radiologist supervision at the direct level.

However, ASRT is still urging support for the Medicare Access to Radiology Care Act as the new rule does not authorize the billing of the procedural portion of diagnostic or therapeutic radiology studies when done in the hospital setting or do not fall under the 'incident to' rule in the office setting.
"We've been pursuing federal RA recognition for more than a decade, so we'd like to thank CMS for using our input to make a decision that's in the best interest of patient care," said Dr. Jackowski. "The new rule, coupled with MARCA, would allow RAs to practice within the full extent of their training and education."

The new rule goes into effect January. 1, 2019.