,,ii  #aai? ,,congress  #a/ ,session    
,s4 #afib  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,may #h1 #bjbe,mrs4    
,blackburn 7= h]self & ,ms4 ,cortez     
,ma/o7 introduc$ ! foll[+ bill2 :i* 0   
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
modify data collection requirem5ts =    
appropriate use crit]ia = applicable    
imag+ s]vices1 & = o!r purposes4  #a4   
,%ort title ,?is ,act may be cit$ z !   
,radiology ,outpati5t ,ord]+            
,transmission 7,,root7 ,act4  #b4       
,modification ( appropriate use crit]ia 
data collection = applicable imag+      
s]vices  7a7 ,9 g5]al ,section #ahcd7q7 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #aciem7q77 is am5d$-- 7#a7 9  
p>agraph 7#c77;,b77ii7-- 7,a7 9         
subclause 7,,iv71 by /rik+ g5]ates &    
provides to ! ord]+ pr(essional a       
c]tification or docum5tation t2 &  7,b7 
by add+ at ! end ! foll[+ new subclause3
  7,,viii7 ,beg9n+ ) ,janu>y #a1 #bjbf1 

! me*anism provides to ! ,secret>y--    
7aa7 ! in=mation describ$ 9 subclauses  
7,,iii7 & 7,,iv72  7bb7 ! in=mation     
describ$ 9 p>agraph 7#d77;,b72 &  7cc7  
su* o!r in=mation z ! ,secret>y det]m9es
 to be appropriate1 at su* "t1 & 9 su*  
=m & mann]1 z ! ,secret>y may specify4  
2  7#b7 9 p>agraph 7#d7-- 7,a7 9        
subp>agraph 7,a71 by /rik+ clause 7ii7 &
 ins]t+ ! foll[+3  7ii7 beg9n+ ,janu>y  
#a1 #bjbf1 comply ) su* requirem5ts z ! 
,secret>y may e/abli%4  2  7,b7 9       
subp>agraph 7,b7-- 7i7 9 ! head+1 by    
/rik+ furni%+ pr(essional & ins]t+      
qualifi$ cl9ical decision support       
me*anism2  7ii7 9 ! matt] prec$+ clause 
7i7-- 7,i7 by /rik+ ,janu>y #a1 #bjag & 
ins]t+ ,janu>y #a1 #bjbf2 &  7,,ii7 by  
/rik+ paym5t = su* s]vice may only be   
made if ! claim = ! s]vice includes &   
ins]t+ ! qualifi$ decision support      
me*anism %all ma9ta9 & report to !      
,secret>y "u subp>agraph 7,f72 &  7iii7 
9 clause 7iii71 by /rik+ 7if diff]5t f !
 furni%+ pr(essional72  7,c7 9          

subp>agraph 7,c71 by add+ at ! end !    
foll[+ new clauses3  7iv7 ,cl9ical      
trials ,an applicable imag+ s]vice t is 
ord]$ = an individual z "p ( a cl9ical  
trial4  7v7 ,small & rural practices ,an
 applicable imag+ s]vice ord]$ by an    
ord]+ pr(essional practic+ 9 a small    
practice 7consi/+ ( #ae or few] ord]+   
pr(essionals71 or a practice 9 a heal?  
pr(essional %ortage area 7z designat$ "u
 section #ccb7;a77#a77;,a7 ( ! ,public  
,heal? ,s]vice ,act7 locat$ 9 a rural   
area4  7vi7 ,specifi$ exemptions ,!     
foll[+ types ( applicable imag+ s]vices3
 7,i7 ,a mammography4  7,,ii7 ,a lung   
canc] scre5+ p]=m$ us+ comput$          
tomography4  7,,iii7 ,a colonography    
p]=m$ us+ comput$ tomography4  7,,iv7   
,su* o!r prev5tive or scre5+ imag+      
s]vices z ! ,secret>y det]m9es          
appropriate4  2  7,d7 9 subp>agraph     
7,d71 by add+ at ! end ! foll[+ new     
clause3  7iv7 ,any o!r paym5t sy/em     
det]m9$ appropriate by ! ,secret>y4  2 &
  7,e7 by add+ at ! end ! foll[+ new    

subp>agraphs3  7,e7 ,furni%+ pr(essional
 requirem5t ,beg9n+ ,janu>y #a1 #bjbf1 )
 respect to an applicable imag+ s]vice  
furni%$ 9 an applicable sett+ & paid =  
"u an applicable paym5t sy/em 7z def9$ 9
 subp>agraph 7,d771 ! furni%+           
pr(essional %all include ! national     
provid] id5tifi] ( ! ord]+ pr(essional  
7if diff]5t f ! furni%+ pr(essional7 on 
! claim = ! s]vice4  7,f7 ,report+      
requirem5ts ,! ,secret>y %all provide1  
?r\gh guidance or rulemak+1 in=mation on
 appropriate ways t ea* qualifi$ cl9ical
 decision support me*anism may report ! 
in=mation ma9ta9$ "u subp>agraph 7,b7 to
 ! ,secret>y to support ! ,secret>y 9   
implem5t+ p>agraphs 7#e7 & 7#f74  2     
7#c7 9 p>agraph 7#e7-- 7,a7 9 ! head+1  
by /rik+ outli] & ins]t+ l[ compliant2  
7,b7 by /rik+ subp>agraphs 7,a7 & 7,b7 &
 ins]t+ ! foll[+3  7,a7 ,9 g5]al ,)     
respect to applicable imag+ s]vices     
furni%$ on or aft] ,janu>y #a1 #bjbf1 ! 
,secret>y %all det]m9e on an annual     
basis ! total numb] ( ord]+ pr(essionals

 :o are designat$ z l[ compliant ord]+  
pr(essionals "u subp>agraph 7,b74  7,b7 
,l[ compliant ord]+ pr(essionals ,!     
,secret>y %all designate ord]+          
pr(essionals ) a compliance rate 7z     
det]m9$ "u subp>agraph 7,d77 l[] ?an an 
am\nt det]m9$ by ! ,secret>y z l[       
compliant ord]+ pr(essionals4  2  7,c7 9
 p>agraph 7,c71 by /rik+ outli] & ins]t+
 l[ compliant2  7,d7 by /rik+           
subp>agraph 7,d7 & ins]t+ ! foll[+3     
7,d7 ,det]m9ation ( compliance rate  7i7
 ,9 g5]al  7,i7 ,compliance rates ,=    
applicable imag+ s]vices furni%$ on or  
aft] ,janu>y #a1 #bjbf1 ! ,secret>y %all
 det]m9e a compliance rate 7z def9$ 9   
clause 7ii77 = ea* ord]+ pr(essional = a
 p]iod specifi$ by ! ,secret>y4  7,,ii7 
,use ( data ,9 det]m9+ a compliance rate
 = an ord]+ pr(essional "u subclause    
7,i71 ! ,secret>y %all use data made    
available to ! ,secret>y by qualifi$    
cl9ical decision support me*anisms      
publi%$ 9 ! li/ "u p>agraph 7#c77;,c7 t 
7 consult$ by ! ord]+ pr(essional = !   

p]iod specifi$ by ! ,secret>y "u        
subclause 7,i74  7ii7 ,def9ition (      
compliance rate  7,i7 ,9 g5]al ,9 ?is   
subp>agraph1 ! t]m compliance rate      
means1 ) respect to ! requirem5t t an   
ord]+ pr(essional consult ) a qualifi$  
decision support me*anism :5 ord]+ an   
applicable imag+ s]vice "u p>agraph     
7#d77;,a77i71 ! ratio 7express$ z a     
p]c5tage7 (-- 7aa7 ! numb] ( claims =   
ord]s = an applicable imag+ s]vice f su*
 ord]+ pr(essional dur+ ! p]iod specifi$
 by ! ,secret>y "u clause 7i77,i7 t     
provid$ ! qualifi$ decision support     
me*anism consult$ by su* ord]+          
pr(essional2 &  7bb7 ! total numb] (    
ord]s = an applicable imag+ s]vice f su*
 ord]+ pr(essional dur+ su* p]iod4      
7,,ii7 ,exclusion ( except$ ord]s ,9    
calculat+ ! compliance rate = an ord]+  
pr(essional "u subclause 7,i71 !        
,secret>y %all exclude f ! total numb] (
 ord]s 9 item 7bb7 ( su* subclause any  
ord] = an applicable imag+ s]vice       
describ$ 9 p>agraph 7#d77;,c74  2 &     

7,e7 9 subp>agraph 7,e71 by /rik+ outli]
 & ins]t+ l[ compliant2  7#d7 by /rik+  
p>agraph 7#f7 & ins]t+ ! foll[+3  7#f7  
,/udy & report on l[ compliant ord]+    
pr(essionals & utilization ( applicable 
imag+ s]vices  7,a7 ,9 g5]al ,n lat] ?an
 ,janu>y #a1 #bjca1 & e #e ye>s !reaft]1
 ! ,secret>y %all conduct a /udy reg>d+ 
! compliance rates calculat$ "u p>agraph
 7#e7 & submit a report to ,congress t--
 7i7 discusses-- 7,i7 su* rates &       
compliance ) ?is subsection2  7,,ii7 !  
impact ?is subsection has on !          
utilization ( applicable imag+ s]vices2 
&  7,,iii7 pot5tial me*anisms = improv+ 
compliance ) ?is subsection1 includ+--  
7aa7 prior au?orization = applicable    
imag+ s]vices ord]$ by l[ compliant     
ord]+ pr(essionals2  7bb7 any paym5t    
adju/m5t relat$ to ! s]vices1 or a      
subset ( s]vices1 t ! ,secret>y may     
designate "u ! fee s*$ule "u section    
#ahdh2 or  7cc7 o!r me*anisms det]m9$   
appropriate by ! ,secret>y2 &  7ii7     
proposes alt]native compliance rate     

?re%olds = l[ compliant ord]+           
pr(essionals = purposes ( p>agraph      
7#e77;,b74  2 &  7#e7 by add+ at ! end !
 foll[+ new p>agraph3  7#h7 ,specialty  
society endorsem5t ,9 specify+          
applicable appropriate use crit]ia =    
applicable imag+ s]vices "u p>agraph    
7#b7 & qualifi$ cl9ical decision support
 me*anisms "u p>agraph 7#c71 ! ,secret>y
 %all sub/antially adh]e to ! approa*   
describ$ 9 section #dad4id ( title #db1 
,code ( ,f$]al ,regulations 7z 9 effect 
on ,janu>y #a1 #bjbc74  4  7b7          
,effective date ,! am5dm5ts made by     
subsection 7a7 %all take effect on      
,janu>y #a1 #bjbf4