119-hr5737

[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.
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