This bill matters to voters because it aims to streamline a part of the healthcare system that can be confusing and burdensome: ordering diagnostic imaging tests. By reducing the administrative steps for doctors, especially those in smaller and rural practices, it could potentially free up their time to focus more on patient care and make it easier to deliver services in underserved areas. For patients, this could mean quicker access to necessary tests, particularly routine screenings that are now explicitly exempt from the consultation requirements.
If this bill becomes law, it could lead to less bureaucracy for many healthcare providers and potentially increase the efficiency of ordering crucial diagnostic tools. If it doesn't pass, the current system of consultation requirements and data collection, which places more administrative burden on individual providers and may not adequately support small or rural practices, would remain in place. The shift in data collection responsibility to the CDSMs themselves, and the new focus on 'low compliant' professionals, represents a significant change in how the government oversees and assesses the appropriate use of imaging services.
KEY PROVISIONS
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PROVISION 01
Clinical Decision Support Mechanisms (CDSMs) will directly report imaging consultation data to the Secretary of HHS starting January 1, 2026.
This centralizes data collection and shifts reporting burden from individual healthcare providers to the technology systems they use.
PROVISION 02
Exempts ordering professionals in small or rural practices and specific imaging services (mammograms, certain CT screenings) from consultation requirements.
This reduces administrative burden for certain providers and improves access to common preventive screenings.
PROVISION 03
Renames 'outlier' ordering professionals to 'low compliant' and changes how their compliance rates are determined, using data reported by CDSMs.
This modifies the framework for identifying and potentially penalizing doctors who frequently do not consult appropriate use criteria.
PROVISION 04
Requires the doctor who performs the imaging service to include the ordering doctor's identification number on the claim for payment.
This ensures clear identification of the ordering professional on claims, supporting better data tracking and compliance monitoring.
PROVISION 05
Mandates the Secretary of HHS to conduct studies and report to Congress every five years on compliance rates and the program's impact, starting in 2031.
This provides ongoing oversight and evaluation of the program's effectiveness and suggests future policy adjustments, like prior authorization for 'low compliant' professionals.
This bill matters to voters because it aims to streamline a part of the healthcare system that can be confusing and burdensome: ordering diagnostic imaging tests. By reducing the administrative steps for doctors, especially those in smaller and rural practices, it could potentially free up their time to focus more on patient care and make it easier to deliver services in underserved areas. For patients, this could mean quicker access to necessary tests, particularly routine screenings that are now explicitly exempt from the consultation requirements.
If this bill becomes law, it could lead to less bureaucracy for many healthcare providers and potentially increase the efficiency of ordering crucial diagnostic tools. If it doesn't pass, the current system of consultation requirements and data collection, which places more administrative burden on individual providers and may not adequately support small or rural practices, would remain in place. The shift in data collection responsibility to the CDSMs themselves, and the new focus on 'low compliant' professionals, represents a significant change in how the government oversees and assesses the appropriate use of imaging services.
KEY PROVISIONS
AI-extracted
high
Clinical Decision Support Mechanisms (CDSMs) will directly report imaging consultation data to the Secretary of HHS starting January 1, 2026.
This centralizes data collection and shifts reporting burden from individual healthcare providers to the technology systems they use.
high
Exempts ordering professionals in small or rural practices and specific imaging services (mammograms, certain CT screenings) from consultation requirements.
This reduces administrative burden for certain providers and improves access to common preventive screenings.
med
Renames 'outlier' ordering professionals to 'low compliant' and changes how their compliance rates are determined, using data reported by CDSMs.
This modifies the framework for identifying and potentially penalizing doctors who frequently do not consult appropriate use criteria.
med
Requires the doctor who performs the imaging service to include the ordering doctor's identification number on the claim for payment.
This ensures clear identification of the ordering professional on claims, supporting better data tracking and compliance monitoring.
med
Mandates the Secretary of HHS to conduct studies and report to Congress every five years on compliance rates and the program's impact, starting in 2031.
This provides ongoing oversight and evaluation of the program's effectiveness and suggests future policy adjustments, like prior authorization for 'low compliant' professionals.
Clinical Decision Support Mechanisms (CDSMs) begin providing information directly to the Secretary and comply with new requirements; changes to data maintenance and reporting by CDSMs become effective; furnishing professionals must include the ordering professional's National Provider Identifier (NPI); determination of 'low compliant' ordering professionals begins.
January 1, 2031 (and every 5 years thereafter)
Secretary must conduct a study and submit a report to Congress regarding compliance rates and impact on imaging utilization.
GLOSSARY
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Appropriate Use Criteria (AUC)
Guidelines developed by medical professional societies to help doctors determine when specific medical imaging procedures are most suitable for a patient's condition.
Applicable Imaging Services
Specific advanced diagnostic imaging tests (like MRI, CT, PET scans) that currently require doctors to consult Appropriate Use Criteria before ordering.
Qualified Clinical Decision Support Mechanism (CDSM)
An electronic system or software that helps doctors apply Appropriate Use Criteria by providing information and guidance at the point of care when ordering imaging services.
Ordering Professional
The doctor or healthcare provider who orders a medical imaging service for a patient.
Furnishing Professional
The doctor or other healthcare professional (e.g., radiologist) who performs or supervises the actual medical imaging service.
National Provider Identifier (NPI)
A unique 10-digit identification number issued to healthcare providers in the United States by the Centers for Medicare & Medicaid Services (CMS).
Health Professional Shortage Area (HPSA)
ACTION TIMELINE
2 EVENTS
MAY 8, 25
Introduced in Senate
INTROREFERRAL
MAY 8, 25
Read twice and referred to the Committee on Finance.
Geographic areas, population groups, or healthcare facilities designated by the Health Resources and Services Administration (HRSA) as having a shortage of primary medical care, dental, or mental health providers.
Secretary
Refers to the Secretary of Health and Human Services (HHS), who oversees many federal health programs, including Medicare.
