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[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5737 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 5737
To amend title XVIII of the Social Security Act to modify data
collection requirements for appropriate use criteria for applicable
imaging services, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 10, 2025
Mrs. Harshbarger (for herself and Mr. Moore of Utah) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committee on Ways and Means, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to modify data
collection requirements for appropriate use criteria for applicable
imaging services, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Radiology Outpatient Ordering
Transmission Act'' or the ``ROOT Act''.
SEC. 2. MODIFICATION OF APPROPRIATE USE CRITERIA DATA COLLECTION FOR
APPLICABLE IMAGING SERVICES.
(a) In General.--Section 1834(q) of the Social Security Act (42
U.S.C. 1395m(q)) is amended--
(1) in paragraph (3)(B)(ii)--
(A) in subclause (IV), by striking ``generates and
provides to the ordering professional a certification
or documentation that''; and
(B) by adding at the end the following new
subclause:
``(VIII) Beginning January 1, 2026,
the mechanism provides to the
Secretary--
``(aa) the information
described in subclauses (III)
and (IV);
``(bb) the information
described in paragraph (4)(B);
and
``(cc) such other
information as the Secretary
determines to be appropriate,
at such time, and in such form
and manner, as the Secretary
may specify.'';
(2) in paragraph (4)--
(A) in subparagraph (A), by striking clause (ii)
and inserting the following:
``(ii) beginning January 1, 2026, comply
with such requirements as the Secretary may
establish.'';
(B) in subparagraph (B)--
(i) in the heading, by striking
``furnishing professional'' and inserting
``qualified clinical decision support
mechanism'';
(ii) in the matter preceding clause (i)--
(I) by striking ``with January 1,
2017'' and inserting ``January 1,
2026''; and
(II) by striking ``payment for such
service may only be made if the claim
for the service includes'' and
inserting ``the qualified decision
support mechanism shall maintain and
report to the Secretary under
subparagraph (F)''; and
(iii) in clause (iii), by striking ``(if
different from the furnishing professional)'';
(C) in subparagraph (C), by adding at the end the
following new clauses:
``(iv) Clinical trials.--An applicable
imaging service that is ordered for an
individual as part of a clinical trial.
``(v) Small and rural practices.--An
applicable imaging service ordered by an
ordering professional practicing in a small
practice (consisting of 15 or fewer ordering
professionals), or a practice in a health
professional shortage area (as designated under
section 332(a)(1)(A) of the Public Health
Service Act) located in a rural area.
``(vi) Specified exemptions.--The following
types of applicable imaging services:
``(I) A mammography.
``(II) A lung cancer screening
performed using computed tomography.
``(III) A colonography performed
using computed tomography.
``(IV) Such other preventive or
screening imaging services as the
Secretary determines appropriate.'';
(D) in subparagraph (D), by adding at the end the
following new clause:
``(iv) Any other payment system determined
appropriate by the Secretary.''; and
(E) by adding at the end the following new
subparagraphs:
``(E) Furnishing professional requirement.--
Beginning January 1, 2026, with respect to an
applicable imaging service furnished in an applicable
setting and paid for under an applicable payment system
(as defined in subparagraph (D)), the furnishing
professional shall include the national provider
identifier of the ordering professional (if different
from the furnishing professional) on the claim for the
service.
``(F) Reporting requirements.--The Secretary shall
provide, through guidance or rulemaking, information on
appropriate ways that each qualified clinical decision
support mechanism may report the information maintained
under subparagraph (B) to the Secretary to support the
Secretary in implementing paragraphs (5) and (6).'';
(3) in paragraph (5)--
(A) in the heading, by striking ``outlier'' and
inserting ``low compliant'';
(B) by striking subparagraphs (A) and (B) and
inserting the following:
``(A) In general.--With respect to applicable
imaging services furnished on or after January 1, 2026,
the Secretary shall determine on an annual basis the
total number of ordering professionals who are
designated as low compliant ordering professionals
under subparagraph (B).
``(B) Low compliant ordering professionals.--The
Secretary shall designate ordering professionals with a
compliance rate (as determined under subparagraph (D))
lower than an amount determined by the Secretary as low
compliant ordering professionals.'';
(C) in paragraph (C), by striking ``outlier'' and
inserting ``low compliant'';
(D) by striking subparagraph (D) and inserting the
following:
``(D) Determination of compliance rate.--
``(i) In general.--
``(I) Compliance rates.--For
applicable imaging services furnished
on or after January 1, 2026, the
Secretary shall determine a compliance
rate (as defined in clause (ii)) for
each ordering professional for a period
specified by the Secretary.
``(II) Use of data.--In determining
a compliance rate for an ordering
professional under subclause (I), the
Secretary shall use data made available
to the Secretary by qualified clinical
decision support mechanisms published
in the list under paragraph (3)(C) that
were consulted by the ordering
professional for the period specified
by the Secretary under subclause (I).
``(ii) Definition of compliance rate.--
``(I) In general.--In this
subparagraph, the term `compliance
rate' means, with respect to the
requirement that an ordering
professional consult with a qualified
decision support mechanism when
ordering an applicable imaging service
under paragraph (4)(A)(i), the ratio
(expressed as a percentage) of--
``(aa) the number of claims
for orders for an applicable
imaging service from such
ordering professional during
the period specified by the
Secretary under clause (i)(I)
that provided the qualified
decision support mechanism
consulted by such ordering
professional; and
``(bb) the total number of
orders for an applicable
imaging service from such
ordering professional during
such period.
``(II) Exclusion of excepted
orders.--In calculating the compliance
rate for an ordering professional under
subclause (I), the Secretary shall
exclude from the total number of orders
in item (bb) of such subclause any
order for an applicable imaging service
described in paragraph (4)(C).''; and
(E) in subparagraph (E), by striking ``outlier''
and inserting ``low compliant'';
(4) by striking paragraph (6) and inserting the following:
``(6) Study and report on low compliant ordering
professionals and utilization of applicable imaging services.--
``(A) In general.--Not later than January 1, 2031,
and every 5 years thereafter, the Secretary shall
conduct a study regarding the compliance rates
calculated under paragraph (5) and submit a report to
Congress that--
``(i) discusses--
``(I) such rates and compliance
with this subsection;
``(II) the impact this subsection
has on the utilization of applicable
imaging services; and
``(III) potential mechanisms for
improving compliance with this
subsection, including--
``(aa) prior authorization
for applicable imaging services
ordered by low compliant
ordering professionals;
``(bb) any payment
adjustment related to the
services, or a subset of
services, that the Secretary
may designate under the fee
schedule under section 1848; or
``(cc) other mechanisms
determined appropriate by the
Secretary; and
``(ii) proposes alternative compliance rate
thresholds for low compliant ordering
professionals for purposes of paragraph
(5)(B).''; and
(5) by adding at the end the following new paragraph:
``(8) Specialty society endorsement.--In specifying
applicable appropriate use criteria for applicable imaging
services under paragraph (2) and qualified clinical decision
support mechanisms under paragraph (3), the Secretary shall
substantially adhere to the approach described in section
414.94 of title 42, Code of Federal Regulations (as in effect
on January 1, 2023).''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect on January 1, 2026.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
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