This bill, the Radiology Outpatient Ordering Transmission Act (ROOT Act), changes rules about how clinical decision support tools for certain outpatient imaging must collect and report data. The bill amends section 1834(q) of the Social Security Act and takes effect January 1, 2026. It directs qualified clinical decision support mechanisms (CDSMs) to maintain and report information to the Secretary of Health and Human Services. The bill replaces earlier 2017 timing with January 1, 2026 for several requirements, requires furnishing professionals to include the ordering professional's national provider identifier (NPI) on claims when different, and asks the Secretary to provide guidance on how CDSMs should report data.
The bill creates exemptions so certain orders are not counted when calculating compliance rates. Exemptions include orders placed as part of clinical trials; orders from small practices (15 or fewer ordering professionals) and practices in health professional shortage areas located in rural areas; and specified screening imaging services such as mammography, lung cancer screening CT, and CT colonography, plus other preventive or screening imaging services the Secretary deems appropriate.
The bill changes language from identifying "outlier" ordering professionals to identifying "low compliant" ordering professionals. The Secretary must calculate a compliance rate for each ordering professional using data from CDSMs. The compliance rate is the share of orders for which the ordering professional consulted a CDSM, excluding exempted orders. The Secretary will designate ordering professionals with compliance rates below a threshold (set by the Secretary) as low compliant. The Secretary must conduct a study and report to Congress by January 1, 2031 and every five years after on compliance rates, the impact on imaging use, and options to improve compliance. The study may consider prior authorization, payment adjustments, or other mechanisms. The Secretary must substantially follow the approach in 42 CFR 414.94 (as of January 1, 2023) when specifying appropriate use criteria and CDSMs.
No publicly available information on estimated costs or savings is provided in the bill text. The bill does direct the Secretary to study and report on possible mechanisms (including potential payment adjustments) to improve compliance, but it does not include cost estimates.
No publicly available information.
No publicly available information.