,i  #aac? ,,congress  #a/ ,session  ,h4 
,r4 #cgje  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,decemb] #aa1         
#bjac,mr4 ,pauls5 7= himself & ,mr4     
,ma!son7 introduc$ ! foll[+ bill2 :i* 0 
ref]r$ to ! ,committee on ,en]gy &      
,comm]ce1 & 9 addition to ! ,committee  
on ,ways & ,means1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
e/abli% appropriat5ess requirem5ts =    
c]ta9 advanc$ diagno/ic imag+ s]vices1 &
 = o!r purposes4  #a4 ,%ort title ,?is  
,act may be cit$ z ! ,excell5ce 9       
,diagno/ic ,imag+ ,utilization ,act (   
#bjac4  #b4 ,appropriat5ess requirem5ts 
= c]ta9 advanc$ diagno/ic imag+ s]vices 
7a7 ,9 g5]al ,section #ahcd ( ! ,social 
,security ,act 7#db ,u4,s4,c4 #aciem7 is
 am5d$ by add+ at ! end ! foll[+ new    
subsection3  7p7 ,appropriat5ess        
requirem5ts = c]ta9 advanc$ diagno/ic   

imag+ s]vices  7#a7 ,9 g5]al  7,a7 ,9   
g5]al ,beg9n+ ) ,janu>y #a1 #bjae1 )    
respect to applicable advanc$ diagno/ic 
imag+ s]vices furni%$ 9 an outpati5t    
sett+ & = :i* paym5t is made "u-- 7i7 ! 
te*nical or pr(essional compon5t ( ! fee
 s*$ule e/abli%$ "u section #ahdh7;b72  
or  7ii7 ! prospective paym5t sy/em =   
hospital outpati5t dep>tm5t s]vices "u  
section #ahcc7t71  paym5t = su* s]vices 
may only be made if ! requirem5ts ( ?is 
subsection are met4  7,b7 ,applicable   
advanc$ diagno/ic imag+ s]vices ,=      
purposes ( ?is subsection1 ! t]m        
applicable advanc$ diagno/ic imag+      
s]vices means advanc$ diagno/ic imag+   
s]vices 7z def9$ 9 subsection           
7e77#a77;,b77 = :i* def9$ appropriate   
use crit]ia 7& relat$ guidel9es7 h be5--
 7i7 develop$ or endors$ by national    
pr(essional m$ical specialty societies2 
&  7ii7 select$ by ! ,secret>y =        
purposes ( ?is subsection 9 consultation
 ) national pr(essional m$ical specialty
 societies & o!r /akehold]s4  7,c7      

,con/ruction 9 in/ances ( multiple      
applicable appropriate use crit]ia ,no?+
 9 ?is subsection %all be con/ru$ z     
prev5t+ ! ,secret>y1 9 ! case t !re are 
multiple appropriate use crit]ia 7&     
relat$ guidel9es7 t are applicable to a 
p>ticul> advanc$ diagno/ic imag+ s]vice 
7or a specific set ( cl9ical            
indications71 f select+ m ?an "o        
crit]ion 7or m ?an "o guidel9e7 "u      
subp>agraph 7,b77ii77,,ii74  7,d7       
,p]iodic revision ,! ,secret>y may      
p]iodically revise ! li/ ( applicable   
advanc$ diagno/ic imag+ s]vices "u ?is  
p>agraph4  7#b7 ,developm5t & ma9t5ance 
( imag+ appropriat5ess regi/ries by     
m$ical specialty societies  7,a7 ,9     
g5]al ,n lat] ?an ,april #a1 #bjad1 !   
,secret>y %all qualify regi/ries t are  
develop$ & ma9ta9$ by national          
pr(essional m$ical specialty societies4 
7,b7 ,requirem5ts ,regi/ries qualifi$ "u
 subp>agraph 7,a7 %all meet ! foll[+    
requirem5ts3 7i7 ,! regi/ry %all        
docum5t-- 7,i7 ! use ( an approv$       

electronic cl9ical decision support tool
 7z describ$ 9 p>agraph 7#c77 9         
connection ) ! ord]+ & p]=mance ( an    
applicable advanc$ diagno/ic imag+      
s]vice2  7,,ii7 :e!r ord]s = applicable 
advanc$ diagno/ic imag+ s]vices 7       
consi/5t ) relat$ appropriate use       
crit]ia 7includ+ an appropriat5ess score
 :]e available f ! approv$ electronic   
cl9ical decision support tool72  7,,iii7
 ! cl9ical indication = ! applicable    
advanc$ diagno/ic imag+ s]vices ord]$2 &
  7,,iv7 9 situations :]e an ord] = an  
applicable advanc$ diagno/ic imag+      
s]vice is n consi/5t ) ! relat$         
appropriate use crit]ia1 ! rationale ( !
 ord]+ or furni%+ suppli] or provid] 7z 
! case may be7 = su* inconsi/5cy4  7ii7 
,! regi/ry %all be /ructur$ to all[     
access to data = future rese>*1 provide 
a c5traliz$ analysis ( ! data submitt$1 
includ+ ! impact on utilization *anges =
 applicable advanc$ diagno/ic s]vices1 &
 provide connections ) exi/+ m$ical     
society regi/ries4  7iii7 ,! regi/ry    

%all g5]ate reports on at lea/ a qu>t]ly
 basis provid+ fe$back to suppli]s &    
provid]s t ord] & furni% applicable     
advanc$ diagno/ic imag+ s]vices on !    
ord]+ activity ( ! suppli] or provid] & 
relat$ appropriate use crit]ia metrics4 
7,c7 ,multiple qualifi$ regi/ries ,9 !  
case :]e m ?an "o regi/ry is develop$ "u
 ?is p>agraph1 ! ,secret>y %all ensure t
 ea* regi/ry receives /&>diz$ data su* t
 ! data may be comb9$ & comp>$ across   
regi/ries4  7,d7 ,p]iodic updat+ ,!     
,secret>y %all p]iodically update ! li/ 
( regi/ries qualifi$ "u ?is p>agraph4   
7#c7 ,li/+ ( qualifi$ suppli]s ( approv$
 electronic cl9ical decision support    
tools  7,a7 ,9 g5]al ,n lat] ?an ,july  
#a1 #bjad1 ! ,secret>y %all publi% a li/
 ( qualifi$ suppli]s ( approv$          
electronic cl9ical decision support     
tools1 9 accordance ) ! provisions ( ?is
 p>agraph4  7,b7 ,/&>ds  7i7 ,9 g5]al ,!
 ,secret>y1 9 consultation ) ! m$ical   
specialty societies describ$ 9 p>agraph 
7#b77;,a71 %all e/abli% /&>ds = !       

approval ( electronic cl9ical decision  
support tools provid$ by qualifi$       
suppli]s4  7ii7 ,/&>ds ,! /&>ds e/abli%$
 "u clause 7i7 %all include ! ability ( 
su* tool to-- 7,i7 use only /&>ds &     
guidel9es develop$ by national m$ical   
specialty societies2  7,,ii7 capture !  
cl9ical indication = ! applicable       
advanc$ diagno/ic imag+ s]vices ord]$1  
select$ f ! relat$ appropriate use      
crit]ia2  7,,iii7 accurately deliv] to !
 ord]+ cl9ician appropriate use crit]ia 
7& relat$ guidel9es7 = applicable       
advanc$ diagno/ic imag+ s]vices1        
reg>dless ( ! physician specialty 7if   
any7 f :i* ! crit]ia or guidel9es       
orig9at$ or to :i* ! crit]ia or         
guidel9es are direct$2  7,,iv7 9 ! case 
:]e !re are multiple /&>ds or guidel9es 
applicable to a p>ticul> s]vice or a    
specific set ( cl9ical indications1     
indicate ! /&>ds or guidel9es t are be+ 
appli$2  7,v7 det]m9e ! appropriat5ess (
 ord]s = su* s]vices2  7,,vi7 submit    
/&>diz$ data to "o or m regi/ries       

qualifi$ "u p>agraph 7#b7 t is suffici5t
 = su* regi/ries to meet _! docum5tation
 obligations "u t p>agraph2  7,,vii7 be 
regul>ly & timely updat$2  7,,viii7     
g5]ate a unique electronic id5tifi]     
7ref]r$ to 9 ?is subsection z a ,cl9ical
 ,decision ,support ,numb]7 t docum5ts !
 fact t ! cl9ical decision support tool 
0 consult$ by ! ord]+ suppli] or provid]
 9 connection ) ! ord]+ ( an applicable 
advanc$ diagno/ic imag+ s]vice2 &       
7,,ix7 p]=m o!r functions det]m9$ to be 
necess>y by ! ,secret>y 9 consultation )
 ! m$ical specialty societies describ$ 9
 p>agraph 7#b77;,a74  7,c7 ,design ,an  
approv$ electronic cl9ical decision     
support tool "u ?is p>agraph-- 7i7 may  
use a web-bas$ portal1 or be imb$d$ into
 an electronic heal? record sy/em or o!r
 heal? in=mation te*nology tool2 &  7ii7
 %all meet ! privacy & security /&>ds "u
 ! regulations promulgat$ pursuant to ! 
,heal? ,insurance ,portability &        
,acc\ntability ,act ( #aiif4  7,d7      
,usage & conv5i5t access requirem5ts ,! 

,secret>y %all only include 9 ! li/     
publi%$ "u ?is p>agraph approv$         
electronic cl9ical decision support     
tools provid$ by suppli]s :o-- 7i7 atte/
 t !y h obta9$ p]mission to incorporate 
appropriate use crit]ia 7& relat$       
guidel9es7 develop$ by national m$ical  
specialty societies2 &  7ii7 demon/rate 
t !y c provide conv5i5t access to su* a 
tool via a secure web-bas$ portal at no 
co/ to-- 7,i7 suppli]s & provid]s :o    
ord] & furni% applicable advanc$        
diagno/ic imag+ s]vices "u ?is title2 & 
7,,ii7 ! ,f$]al gov]nm5t4  7,e7 ,p]iodic
 updat+ ,! ,secret>y %all p]iodically   
update ! li/ ( qualifi$ suppli]s (      
approv$ electronic cl9ical decision     
support tools t meet ! /&>ds e/abli%$ "u
 subp>agraph 7,b7 & ! o!r requirem5ts ( 
?is p>agraph4  7#d7 ,consultation       
requirem5t ,! ,secret>y %all require t1 
z a condition ( p>ticipation 9 ! program
 "u ?is title1 suppli]s & provid]s :o   
ord] an applicable advanc$ diagno/ic    
imag+ s]vice %all agree to consult an   

approv$ electronic cl9ical decision     
support tool li/$ pursuant to p>agraph  
7#c7 9 connection ) su* ord]4  7#e7     
,paym5t = s]vices cont+5t ^u regi/ry    
submission  7,a7 ,9 g5]al ,) respect to 
an applicable advanc$ diagno/ic imag+   
s]vice1 paym5t = ! te*nical or          
pr(essional compon5t ( su* s]vice "u !  
fee s*$ule e/abli%$ "u section #ahdh7;b7
 or "u ! prospective paym5t sy/em =     
hospital outpati5t dep>tm5t s]vices "u  
section #ahcc7t7 may only be made if !  
docum5tation accompany+ any su* claim = 
paym5t demon/rates t an approv$         
electronic cl9ical decision support tool
 li/$ pursuant to p>agraph 7#c7 0       
consult$ & ! requir$ in=mation 0        
submitt$ to a regi/ry qualifi$ "u       
p>agraph 7#b74  7,b7 ,demon/ration (    
compliance ,compliance ) ! requirem5ts  
"u subp>agraph 7,a7 may be demon/rat$ by
 ! inclusion ( a ,cl9ical ,decision     
,support ,numb] ) ! claim = paym5t4     
7#f7 ,exemptions  7,a7 ,significant     
h>d%ip exemption ,! ,secret>y may1 on a 

case-by-case basis1 exempt a suppli] or 
provid] to :om ?is subsection w\ld      
o!rwise apply if ! ,secret>y det]m9es1  
subject to annual r5ewal1 t compliance )
 ?is subsection w\ld result 9 a         
significant h>d%ip1 su* z 9 ! case ( a  
suppli] or provid] :o lacks access to an
 electronic records sy/em or high-spe$  
,int]net access4  7,b7 ,em]g5cy s]vices 
exemption ,applicable advanc$ diagno/ic 
imag+ s]vices ord]$ em]g5tly z "p ( an  
em]g5cy m$ical evaluation %all n be     
subject to ! requirem5ts ( ?is          
subsection4  7,c7 ,cl>ification (       
inapplicability to inpati5t s]vices     
,advanc$ diagno/ic imag+ s]vices ord]$ =
 inpati5ts & = :i* paym5t is made "u "p 
,a are n subject to ! requirem5ts ( ?is 
subsection4  7#g7 ,limitations ,!       
,secret>y may n utilize ! au?ority      
provid$ "u ?is subsection to-- 7,a7     
impose any requirem5t t a suppli] or    
provid] obta9 approval to ord] an       
advanc$ diagno/ic imag+ s]vice be=e     
p]=m+ su* s]vice or any o!r requirem5t =

 prior au?orization ) respect to su*    
s]vice2 or  7,b7 use approv$ electronic 
cl9ical decision support tools to make  
claims paym5t det]m9ations "u ?is title4
  7#h7 ,rulemak+ reg>d+ pati5t safety ,!
 ,secret>y %all promulgate regulations  
to address situations 9 :i* a suppli] or
 provid]1 prior to p]=m+ an applicable  
advanc$ diagno/ic imag+ s]vice = an     
individual1 reasonably believes t !     
s]vice ord]$1 if p]=m$1 w\ld pose a     
safety risk to ! individual & t a       
diff]5t imag+ s]vice is m appropriate "u
 ! circum/ances4 ,su* regulations %all  
def9e circum/ances 9 :i* ! suppli] or   
provid] may *ange ! ord] to an imag+    
s]vice ! suppli] or provid] det]m9es is 
m appropriate4  4  7b7 ,compliance )    
appropriat5ess regi/ry treat$ z         
satisfactory quality report+ ,section   
#ahdh7m77#c7 ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #aciew-#d7m77#c77 is     
am5d$-- 7#a7 by r$esignat+ subp>agraph  
7,f7 z subp>agraph 7,h72 &  7#b7 by     
ins]t+ aft] subp>agraph 7,e7 ! foll[+   

new subp>agraphs3  7,f7 ,satisfactory   
report+ measures ?r\gh p>ticipation 9   
imag+ appropriat5ess regi/ry  7i7 ,9    
g5]al ,= #bjae & subsequ5t ye>s1 !      
,secret>y %all treat an eligible        
pr(essional describ$ 9 clause 7ii7 z    
satisfactorily submitt+ data on quality 
measures "u subp>agraph 7,a7 if1 in/ead 
( report+ measures "u subsection        
7k77#b77;,c71 ! eligible pr(essional    
provides evid5ce1 9 a =m & mann]        
specifi$ by ! ,secret>y1 demon/rat+ t ! 
regi/ry submission requirem5ts "u       
section #ahcc7p77#e7 h be5 compli$ ) )  
respect to n less ?an #ij p]c5t ( claims
 = applicable advanc$ diagno/ic imag+   
s]vices 7z def9$ 9 section              
#ahcc7p77#a77;,b77 submitt$ by !        
eligible pr(essional 9 ! ye>4  7ii7     
,eligible pr(essional describ$ ,=       
purposes ( clause 7i71 an eligible      
pr(essional describ$ 9 ?is clause is an 
eligible pr(essional :o furni%es !      
te*nical or pr(essional compon5t (      
applicable advanc$ diagno/ic imag+      

s]vices 7z s def9$74  7,g7 ,satisfactory
 report+ measures ?r\gh p>ticipation 9  
imag+ appropriat5ess regi/ry  7i7 ,9    
g5]al ,= #bjae & subsequ5t ye>s1 !      
,secret>y %all treat an eligible        
pr(essional describ$ 9 clause 7ii7 z    
satisfactorily submitt+ data on quality 
measures "u subp>agraph 7,a7 if1 9 lieu 
( report+ measures "u subsection        
7k77#b77;,c71 ! eligible pr(essional    
provides evid5ce1 9 a =m & mann]        
specifi$ by ! ,secret>y1 demon/rat+ t !y
 h compli$ ) ! consultation requirem5ts 
"u section #ahcc7p77#d7 ) respect to n  
less ?an #ij p]c5t ( claims = applicable
 advanc$ diagno/ic imag+ s]vices 7z s   
def9$7 submitt$ by ! eligible           
pr(essional 9 ! ye>4  7ii7 ,eligible    
pr(essional describ$ ,= purposes (      
clause 7i71 an eligible pr(essional     
describ$ 9 ?is clause is an eligible    
pr(essional :o ord]s applicable advanc$ 
diagno/ic imag+ s]vices 7z s def9$74  4 
7c7 ,con=m+ am5dm5t ,section            
#ahcc7t77#af7 ( ! ,social ,security ,act

 7#db ,u4,s4,c4 #aciel7t77#af77 is am5d$
 by add+ at ! end ! foll[+ new          
subp>agraph3  7,e7 ,application (       
appropriat5ess requirem5ts = c]ta9      
advanc$ diagno/ic imag+ s]vices ,=      
provisions relat+ to ! application (    
appropriat5ess requirem5ts = c]ta9      
advanc$ diagno/ic imag+ s]vices1 see    
section #ahcd7p74  4