,i #aacth ,,congress #ast ,session ,h4 ,r4 #cgje ,,in ,,the ,,house ,,of ,,representatives ,december #aa1 #bjac,mr4 ,paulsen 7for himself and ,mr4 ,matheson7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 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 establish appropriateness requirements for certain advanced diagnostic imaging services1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,excellence in ,diagnostic ,imaging ,utilization ,act of #bjac4 #b4 ,appropriateness requirements for certain advanced diagnostic imaging services 7a7 ,in general ,section #ahcd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7 is amended by adding at the end the following new subsection3 7p7 ,appropriateness requirements for certain advanced diagnostic imaging services 7#a7 ,in general 7,a7 ,in general ,beginning with ,january #a1 #bjae1 with respect to applicable advanced diagnostic imaging services furnished in an outpatient setting and for which payment is made under-- 7i7 the technical or professional component of the fee schedule established under section #ahdh7;b72 or 7ii7 the prospective payment system for hospital outpatient department services under section #ahcc7t71 payment for such services may only be made if the requirements of this subsection are met4 7,b7 ,applicable advanced diagnostic imaging services ,for purposes of this subsection1 the term applicable advanced diagnostic imaging services means advanced diagnostic imaging services 7as defined in subsection 7e77#a77;,b77 for which defined appropriate use criteria 7and related guidelines7 have been-- 7i7 developed or endorsed by national professional medical specialty societies2 and 7ii7 selected by the ,secretary for purposes of this subsection in consultation with national professional medical specialty societies and other stakeholders4 7,c7 ,construction in instances of multiple applicable appropriate use criteria ,nothing in this subsection shall be construed as preventing the ,secretary1 in the case that there are multiple appropriate use criteria 7and related guidelines7 that are applicable to a particular advanced diagnostic imaging service 7or a specific set of clinical indications71 from selecting more than one criterion 7or more than one guideline7 under subparagraph 7,b77ii77,,ii74 7,d7 ,periodic revision ,the ,secretary may periodically revise the list of applicable advanced diagnostic imaging services under this paragraph4 7#b7 ,development and maintenance of imaging appropriateness registries by medical specialty societies 7,a7 ,in general ,not later than ,april #a1 #bjad1 the ,secretary shall qualify registries that are developed and maintained by national professional medical specialty societies4 7,b7 ,requirements ,registries qualified under subparagraph 7,a7 shall meet the following requirements3 7i7 ,the registry shall document-- 7,i7 the use of an approved electronic clinical decision support tool 7as described in paragraph 7#c77 in connection with the ordering and performance of an applicable advanced diagnostic imaging service2 7,,ii7 whether orders for applicable advanced diagnostic imaging services were consistent with related appropriate use criteria 7including an appropriateness score where available from the approved electronic clinical decision support tool72 7,,iii7 the clinical indication for the applicable advanced diagnostic imaging services ordered2 and 7,,iv7 in situations where an order for an applicable advanced diagnostic imaging service is not consistent with the related appropriate use criteria1 the rationale of the ordering or furnishing supplier or provider 7as the case may be7 for such inconsistency4 7ii7 ,the registry shall be structured to allow access to data for future research1 provide a centralized analysis of the data submitted1 including the impact on utilization changes for applicable advanced diagnostic services1 and provide connections with existing medical society registries4 7iii7 ,the registry shall generate reports on at least a quarterly basis providing feedback to suppliers and providers that order and furnish applicable advanced diagnostic imaging services on the ordering activity of the supplier or provider and related appropriate use criteria metrics4 7,c7 ,multiple qualified registries ,in the case where more than one registry is developed under this paragraph1 the ,secretary shall ensure that each registry receives standardized data such that the data may be combined and compared across registries4 7,d7 ,periodic updating ,the ,secretary shall periodically update the list of registries qualified under this paragraph4 7#c7 ,listing of qualified suppliers of approved electronic clinical decision support tools 7,a7 ,in general ,not later than ,july #a1 #bjad1 the ,secretary shall publish a list of qualified suppliers of approved electronic clinical decision support tools1 in accordance with the provisions of this paragraph4 7,b7 ,standards 7i7 ,in general ,the ,secretary1 in consultation with the medical specialty societies described in paragraph 7#b77;,a71 shall establish standards for the approval of electronic clinical decision support tools provided by qualified suppliers4 7ii7 ,standards ,the standards established under clause 7i7 shall include the ability of such tool to-- 7,i7 use only standards and guidelines developed by national medical specialty societies2 7,,ii7 capture the clinical indication for the applicable advanced diagnostic imaging services ordered1 selected from the related appropriate use criteria2 7,,iii7 accurately deliver to the ordering clinician appropriate use criteria 7and related guidelines7 for applicable advanced diagnostic imaging services1 regardless of the physician specialty 7if any7 from which the criteria or guidelines originated or to which the criteria or guidelines are directed2 7,,iv7 in the case where there are multiple standards or guidelines applicable to a particular service or a specific set of clinical indications1 indicate the standards or guidelines that are being applied2 7,v7 determine the appropriateness of orders for such services2 7,,vi7 submit standardized data to one or more registries qualified under paragraph 7#b7 that is sufficient for such registries to meet their documentation obligations under that paragraph2 7,,vii7 be regularly and timely updated2 7,,viii7 generate a unique electronic identifier 7referred to in this subsection as a ,clinical ,decision ,support ,number7 that documents the fact that the clinical decision support tool was consulted by the ordering supplier or provider in connection with the ordering of an applicable advanced diagnostic imaging service2 and 7,,ix7 perform other functions determined to be necessary by the ,secretary in consultation with the medical specialty societies described in paragraph 7#b77;,a74 7,c7 ,design ,an approved electronic clinical decision support tool under this paragraph-- 7i7 may use a web-based portal1 or be imbedded into an electronic health record system or other health information technology tool2 and 7ii7 shall meet the privacy and security standards under the regulations promulgated pursuant to the ,health ,insurance ,portability and ,accountability ,act of #aiif4 7,d7 ,usage and convenient access requirements ,the ,secretary shall only include in the list published under this paragraph approved electronic clinical decision support tools provided by suppliers who-- 7i7 attest that they have obtained permission to incorporate appropriate use criteria 7and related guidelines7 developed by national medical specialty societies2 and 7ii7 demonstrate that they can provide convenient access to such a tool via a secure web-based portal at no cost to-- 7,i7 suppliers and providers who order and furnish applicable advanced diagnostic imaging services under this title2 and 7,,ii7 the ,federal government4 7,e7 ,periodic updating ,the ,secretary shall periodically update the list of qualified suppliers of approved electronic clinical decision support tools that meet the standards established under subparagraph 7,b7 and the other requirements of this paragraph4 7#d7 ,consultation requirement ,the ,secretary shall require that1 as a condition of participation in the program under this title1 suppliers and providers who order an applicable advanced diagnostic imaging service shall agree to consult an approved electronic clinical decision support tool listed pursuant to paragraph 7#c7 in connection with such order4 7#e7 ,payment for services contingent upon registry submission 7,a7 ,in general ,with respect to an applicable advanced diagnostic imaging service1 payment for the technical or professional component of such service under the fee schedule established under section #ahdh7;b7 or under the prospective payment system for hospital outpatient department services under section #ahcc7t7 may only be made if the documentation accompanying any such claim for payment demonstrates that an approved electronic clinical decision support tool listed pursuant to paragraph 7#c7 was consulted and the required information was submitted to a registry qualified under paragraph 7#b74 7,b7 ,demonstration of compliance ,compliance with the requirements under subparagraph 7,a7 may be demonstrated by the inclusion of a ,clinical ,decision ,support ,number with the claim for payment4 7#f7 ,exemptions 7,a7 ,significant hardship exemption ,the ,secretary may1 on a case-by-case basis1 exempt a supplier or provider to whom this subsection would otherwise apply if the ,secretary determines1 subject to annual renewal1 that compliance with this subsection would result in a significant hardship1 such as in the case of a supplier or provider who lacks access to an electronic records system or high-speed ,internet access4 7,b7 ,emergency services exemption ,applicable advanced diagnostic imaging services ordered emergently as part of an emergency medical evaluation shall not be subject to the requirements of this subsection4 7,c7 ,clarification of inapplicability to inpatient services ,advanced diagnostic imaging services ordered for inpatients and for which payment is made under part ,a are not subject to the requirements of this subsection4 7#g7 ,limitations ,the ,secretary may not utilize the authority provided under this subsection to-- 7,a7 impose any requirement that a supplier or provider obtain approval to order an advanced diagnostic imaging service before performing such service or any other requirement for prior authorization with respect to such service2 or 7,b7 use approved electronic clinical decision support tools to make claims payment determinations under this title4 7#h7 ,rulemaking regarding patient safety ,the ,secretary shall promulgate regulations to address situations in which a supplier or provider1 prior to performing an applicable advanced diagnostic imaging service for an individual1 reasonably believes that the service ordered1 if performed1 would pose a safety risk to the individual and that a different imaging service is more appropriate under the circumstances4 ,such regulations shall define circumstances in which the supplier or provider may change the order to an imaging service the supplier or provider determines is more appropriate4 4 7b7 ,compliance with appropriateness registry treated as satisfactory quality reporting ,section #ahdh7m77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7m77#c77 is amended-- 7#a7 by redesignating subparagraph 7,f7 as subparagraph 7,h72 and 7#b7 by inserting after subparagraph 7,e7 the following new subparagraphs3 7,f7 ,satisfactory reporting measures through participation in imaging appropriateness registry 7i7 ,in general ,for #bjae and subsequent years1 the ,secretary shall treat an eligible professional described in clause 7ii7 as satisfactorily submitting data on quality measures under subparagraph 7,a7 if1 instead of reporting measures under subsection 7k77#b77;,c71 the eligible professional provides evidence1 in a form and manner specified by the ,secretary1 demonstrating that the registry submission requirements under section #ahcc7p77#e7 have been complied with with respect to not less than #ij percent of claims for applicable advanced diagnostic imaging services 7as defined in section #ahcc7p77#a77;,b77 submitted by the eligible professional in the year4 7ii7 ,eligible professional described ,for purposes of clause 7i71 an eligible professional described in this clause is an eligible professional who furnishes the technical or professional component of applicable advanced diagnostic imaging services 7as so defined74 7,g7 ,satisfactory reporting measures through participation in imaging appropriateness registry 7i7 ,in general ,for #bjae and subsequent years1 the ,secretary shall treat an eligible professional described in clause 7ii7 as satisfactorily submitting data on quality measures under subparagraph 7,a7 if1 in lieu of reporting measures under subsection 7k77#b77;,c71 the eligible professional provides evidence1 in a form and manner specified by the ,secretary1 demonstrating that they have complied with the consultation requirements under section #ahcc7p77#d7 with respect to not less than #ij percent of claims for applicable advanced diagnostic imaging services 7as so defined7 submitted by the eligible professional in the year4 7ii7 ,eligible professional described ,for purposes of clause 7i71 an eligible professional described in this clause is an eligible professional who orders applicable advanced diagnostic imaging services 7as so defined74 4 7c7 ,conforming amendment ,section #ahcc7t77#af7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7t77#af77 is amended by adding at the end the following new subparagraph3 7,e7 ,application of appropriateness requirements for certain advanced diagnostic imaging services ,for provisions relating to the application of appropriateness requirements for certain advanced diagnostic imaging services1 see section #ahcd7p74 4