ROOT Act
Sponsored By: Representative Harshbarger
Introduced
Summary
Shifts Medicare imaging reporting from clinicians to qualified clinical decision support mechanisms (QCDSMs). The ROOT Act would create a new data-reporting framework, set a January 1, 2026 start for QCDSM submissions, and add targeted exemptions and a revamped compliance system.
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- QCDSMs and vendors: Would be required to transmit expanded appropriate use criteria (AUC) data and other Secretary-specified information to HHS in the form and manner the Secretary sets starting January 1, 2026.
- Ordering clinicians and small or rural practices: Would see reporting responsibility moved away from the furnishing professional. The bill would require the ordering professional's national provider identifier (NPI) on claims when paid under applicable systems and would exempt small practices (15 or fewer ordering professionals) and practices in rural health professional shortage areas. It also exempts specified screening imaging such as mammography and lung cancer CT.
- Medicare oversight and payment rules: Would relabel the compliance framework as "low compliant," define compliance rates, allow the Secretary to consider payment adjustments or prior authorization for low compliant professionals, and require a study and report to Congress by January 1, 2031 and every five years on compliance and imaging use.
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Bill Overview
Analyzed Economic Effects
3 provisions identified: 1 benefits, 1 costs, 1 mixed.
Compliance scores for imaging ordering clinicians
Beginning January 1, 2026, HHS would calculate a yearly compliance rate for each clinician who orders imaging. The rate would track how often an approved decision tool was used. Clinicians below an HHS-set threshold would be labeled “low compliant.” Orders in clinical trials, from small or rural shortage-area practices, and certain screening tests would not count. If labeled, clinicians could face added review or rules that HHS may set.
New reporting and billing rules for imaging
Starting January 1, 2026, the software tool used to check imaging orders would have to keep and send data to HHS in the way HHS sets. This would replace the old rule that tied payment to putting detailed decision-tool data on the claim. Providers would still need to list the ordering clinician’s NPI on the claim when paid under an applicable system and the orderer is different. HHS could add more payment systems to these rules and must follow the approach in place on January 1, 2023. Net: vendors would do more reporting; providers may have less claim data but a new claim field.
Exemptions for small, rural, and screening imaging
Starting January 1, 2026, some imaging orders would not require a decision-tool check. Clinical trial orders would be exempt. Clinicians in small practices (15 or fewer ordering professionals) or in rural health professional shortage areas would be exempt. Screening tests like mammograms, lung CT screening, and CT colonography would be exempt, plus other preventive imaging HHS may list. These orders also would not count against a clinician’s compliance rate.
Sponsors & CoSponsors
Sponsor
Harshbarger
TN • R
Cosponsors
Moore (UT)
UT • R
Sponsored 10/10/2025
Roll Call Votes
No roll call votes available for this bill.
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