H.R. 5737

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5737 Introduced in House (IH)]

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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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