To amend title XVIII of the Social Security Act to modify data collection requirements for appropriate use criteria for applicable imaging services, and for other purposes.
Analysis under review: This bill has generated analysis that may be too generic or incomplete. Clause-level evidence remains available below.
Summary
What This Bill Does
Reworks Medicare's appropriate use criteria data collection regime for advanced imaging by shifting more reporting responsibility to qualified clinical decision support mechanisms, exempting additional services and practices, and giving the Secretary broader implementation authority.
Who Benefits and How
Ordering professionals, especially small and rural practices, and providers furnishing exempted screening services could face fewer direct claim-side appropriate-use-criteria burdens.
Who Bears the Burden and How
Qualified clinical decision support mechanism operators and CMS would need to handle revised reporting, compliance, and implementation duties.
Key Provisions
- Requires qualified clinical decision support mechanisms to provide specified information to the Secretary beginning January 1, 2026.
- Exempts clinical-trial imaging, certain small and rural practices, and specified screening services from parts of the program.
- Replaces the outlier ordering-professional framework with a low-compliant framework and gives the Secretary broad authority over reporting and implementation.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers.
At a Glance
What This Bill Does
Reworks Medicare's appropriate use criteria data collection regime for advanced imaging by shifting more reporting responsibility to qualified clinical decision support mechanisms, exempting additional services and practices, and giving the Secretary broader implementation authority.
Key Policy Areas
Healthcare, Technology, Government Operations
Primary Purpose
Reworks Medicare's appropriate use criteria data collection regime for advanced imaging by shifting more reporting responsibility to qualified clinical decision support mechanisms, exempting additional services and practices, and giving the Secretary broader implementation authority.
Policy Domains
Main Provisions
Identified Gains
Contextual inference, no direct clause citation- Ordering professionals and furnishing professionals facing reduced direct appropriate-use-criteria claim burdens
- Qualified clinical decision support mechanism vendors positioned to serve as reporting intermediaries
Contextual inference, no direct clause citation
Identified Costs
Contextual inference, no direct clause citation- Qualified clinical decision support mechanism operators and CMS officials required to maintain, receive, and use the revised reporting data
Contextual inference, no direct clause citation
Sponsors
Legislative Progress
IntroducedMrs. Harshbarger (for herself and Mr. Moore of Utah) introduced …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Ordering professionals and furnishing professionals whose direct compliance burden is eased by revised exemptions and claim requirements
CMS officials implementing and using the revised imaging reporting regime
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "the_secretary"
- → Secretary of Health and Human Services
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology