,,ii #aaith ,,congress #ast ,session ,s4 #afib ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #h1 #bjbe,mrs4 ,blackburn 7for herself and ,ms4 ,cortez ,masto7 introduced the following bill2 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 services1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,radiology ,outpatient ,ordering ,transmission 7,,root7 ,act4 #b4 ,modification of appropriate use criteria data collection for applicable imaging services 7a7 ,in general ,section #ahcd7q7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7q77 is amended-- 7#a7 in paragraph 7#c77;,b77ii7-- 7,a7 in subclause 7,,iv71 by striking generates and provides to the ordering professional a certification or documentation that2 and 7,b7 by adding at the end the following new subclause3 7,,viii7 ,beginning with ,january #a1 #bjbf1 the mechanism provides to the ,secretary-- 7aa7 the information described in subclauses 7,,iii7 and 7,,iv72 7bb7 the information described in paragraph 7#d77;,b72 and 7cc7 such other information as the ,secretary determines to be appropriate1 at such time1 and in such form and manner1 as the ,secretary may specify4 2 7#b7 in paragraph 7#d7-- 7,a7 in subparagraph 7,a71 by striking clause 7ii7 and inserting the following3 7ii7 beginning ,january #a1 #bjbf1 comply with such requirements as the ,secretary may establish4 2 7,b7 in subparagraph 7,b7-- 7i7 in the heading1 by striking furnishing professional and inserting qualified clinical decision support mechanism2 7ii7 in the matter preceding clause 7i7-- 7,i7 by striking ,january #a1 #bjag and inserting ,january #a1 #bjbf2 and 7,,ii7 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 7,f72 and 7iii7 in clause 7iii71 by striking 7if different from the furnishing professional72 7,c7 in subparagraph 7,c71 by adding at the end the following new clauses3 7iv7 ,clinical trials ,an applicable imaging service that is ordered for an individual as part of a clinical trial4 7v7 ,small and rural practices ,an applicable imaging service ordered by an ordering professional practicing in a small practice 7consisting of #ae or fewer ordering professionals71 or a practice in a health professional shortage area 7as designated under section #ccb7;a77#a77;,a7 of the ,public ,health ,service ,act7 located in a rural area4 7vi7 ,specified exemptions ,the following types of applicable imaging services3 7,i7 ,a mammography4 7,,ii7 ,a lung cancer screening performed using computed tomography4 7,,iii7 ,a colonography performed using computed tomography4 7,,iv7 ,such other preventive or screening imaging services as the ,secretary determines appropriate4 2 7,d7 in subparagraph 7,d71 by adding at the end the following new clause3 7iv7 ,any other payment system determined appropriate by the ,secretary4 2 and 7,e7 by adding at the end the following new subparagraphs3 7,e7 ,furnishing professional requirement ,beginning ,january #a1 #bjbf1 with respect to an applicable imaging service furnished in an applicable setting and paid for under an applicable payment system 7as defined in subparagraph 7,d771 the furnishing professional shall include the national provider identifier of the ordering professional 7if different from the furnishing professional7 on the claim for the service4 7,f7 ,reporting requirements ,the ,secretary shall provide1 through guidance or rulemaking1 information on appropriate ways that each qualified clinical decision support mechanism may report the information maintained under subparagraph 7,b7 to the ,secretary to support the ,secretary in implementing paragraphs 7#e7 and 7#f74 2 7#c7 in paragraph 7#e7-- 7,a7 in the heading1 by striking outlier and inserting low compliant2 7,b7 by striking subparagraphs 7,a7 and 7,b7 and inserting the following3 7,a7 ,in general ,with respect to applicable imaging services furnished on or after ,january #a1 #bjbf1 the ,secretary shall determine on an annual basis the total number of ordering professionals who are designated as low compliant ordering professionals under subparagraph 7,b74 7,b7 ,low compliant ordering professionals ,the ,secretary shall designate ordering professionals with a compliance rate 7as determined under subparagraph 7,d77 lower than an amount determined by the ,secretary as low compliant ordering professionals4 2 7,c7 in paragraph 7,c71 by striking outlier and inserting low compliant2 7,d7 by striking subparagraph 7,d7 and inserting the following3 7,d7 ,determination of compliance rate 7i7 ,in general 7,i7 ,compliance rates ,for applicable imaging services furnished on or after ,january #a1 #bjbf1 the ,secretary shall determine a compliance rate 7as defined in clause 7ii77 for each ordering professional for a period specified by the ,secretary4 7,,ii7 ,use of data ,in determining a compliance rate for an ordering professional under subclause 7,i71 the ,secretary shall use data made available to the ,secretary by qualified clinical decision support mechanisms published in the list under paragraph 7#c77;,c7 that were consulted by the ordering professional for the period specified by the ,secretary under subclause 7,i74 7ii7 ,definition of compliance rate 7,i7 ,in general ,in this subparagraph1 the term compliance rate means1 with respect to the requirement that an ordering professional consult with a qualified decision support mechanism when ordering an applicable imaging service under paragraph 7#d77;,a77i71 the ratio 7expressed as a percentage7 of-- 7aa7 the number of claims for orders for an applicable imaging service from such ordering professional during the period specified by the ,secretary under clause 7i77,i7 that provided the qualified decision support mechanism consulted by such ordering professional2 and 7bb7 the total number of orders for an applicable imaging service from such ordering professional during such period4 7,,ii7 ,exclusion of excepted orders ,in calculating the compliance rate for an ordering professional under subclause 7,i71 the ,secretary shall exclude from the total number of orders in item 7bb7 of such subclause any order for an applicable imaging service described in paragraph 7#d77;,c74 2 and 7,e7 in subparagraph 7,e71 by striking outlier and inserting low compliant2 7#d7 by striking paragraph 7#f7 and inserting the following3 7#f7 ,study and report on low compliant ordering professionals and utilization of applicable imaging services 7,a7 ,in general ,not later than ,january #a1 #bjca1 and every #e years thereafter1 the ,secretary shall conduct a study regarding the compliance rates calculated under paragraph 7#e7 and submit a report to ,congress that-- 7i7 discusses-- 7,i7 such rates and compliance with this subsection2 7,,ii7 the impact this subsection has on the utilization of applicable imaging services2 and 7,,iii7 potential mechanisms for improving compliance with this subsection1 including-- 7aa7 prior authorization for applicable imaging services ordered by low compliant ordering professionals2 7bb7 any payment adjustment related to the services1 or a subset of services1 that the ,secretary may designate under the fee schedule under section #ahdh2 or 7cc7 other mechanisms determined appropriate by the ,secretary2 and 7ii7 proposes alternative compliance rate thresholds for low compliant ordering professionals for purposes of paragraph 7#e77;,b74 2 and 7#e7 by adding at the end the following new paragraph3 7#h7 ,specialty society endorsement ,in specifying applicable appropriate use criteria for applicable imaging services under paragraph 7#b7 and qualified clinical decision support mechanisms under paragraph 7#c71 the ,secretary shall substantially adhere to the approach described in section #dad4id of title #db1 ,code of ,federal ,regulations 7as in effect on ,january #a1 #bjbc74 4 7b7 ,effective date ,the amendments made by subsection 7a7 shall take effect on ,january #a1 #bjbf4