Committee considers updating supervision rules to allow virtual supervision and APRN/PA direct supervision for IV contrast
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Summary
House Bill 2,113 would permit IV-contrast procedures to be supervised virtually by physicians via real-time audio/video or directly by an ARNP or PA; sponsors said the change aligns state law with CMS and preserves rural access, while radiologists suggested proximity safeguards for virtual supervision.
House Bill 2,113 would modify supervision rules for certain radiologic technologists performing parenteral procedures. Staff explained the bill allows IV-contrast procedures to occur under virtual direct supervision by a physician via real-time interactive audio/video technology or under direct supervision by a physician, advanced practice registered nurse or physician assistant; other parenteral procedures would continue to require physician direct supervision. The bill also requires that trained staff capable of responding to adverse events be present on-site.
Representative Engel, the sponsor, said the change corrects a statutory conflict that prevented advanced practice providers from supervising contrast procedures in some settings and that the bill aligns Washington with permanent CMS policy allowing virtual direct supervision. Supporters from rural hospitals, PAs and nurse anesthesiology groups said the bill protects access to timely diagnostics in facilities that lack on-site physicians 24/7.
Radiology stakeholders, while broadly supportive, recommended practical amendments. Ed Kim (Washington State Radiological Society) urged a distance or proximity requirement so a supervising physician could reach a facility within a reasonable time if in-person care becomes necessary and to ensure familiarity with local resources. Witnesses discussed that certain reactions to IV contrast may evolve over time and that on-site competent staff are critical.
The committee closed the public hearing on HB 2,113; sponsors and stakeholders noted the bill resulted from multi-stakeholder negotiation and suggested modest technical amendments to address proximity and training concerns.
