S. 1692

119 S1692 IS: Radiology Outpatient Ordering Transmission (ROOT) Act
 U.S. Senate
 2025-05-08
 text/xml
 EN
 Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
 II  119th CONGRESS  1st Session  S. 1692  IN THE SENATE OF THE UNITED STATES   May 8, 2025   Mrs. Blackburn  (for herself and
  Ms. Cortez Masto ) introduced the following
  bill; which was read twice and referred to the  Committee on Finance    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.
1.
Short title
This Act may be cited as the   Radiology Outpatient Ordering Transmission (ROOT) Act  .
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 with 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  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.