I 

109TH CONGRESS 

1ST SESSION H. R. 1426 

To amend title XIX of the Social Security Act to provide public access 

to quality medical imaging procedures and radiation therapy procedures. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 17, 2005 

Mr. PICKERING (for himself, Mr. DOYLE, Mr. TAYLOR of Mississippi, Mr. 

LARSON of Connecticut, Mr. LYNCH, Mr. TANNER, Mr. DUNCAN, Mr. 

KILDEE, Mr. MCCOTTER, Mr. ABERCROMBIE, Mr. WICKER, Mr. RYUN of 

Kansas, Mr. PAYNE, Mr. HYDE, Mr. HINCHEY, Mr. WALSH, Mr. TERRY, 

Mrs. WILSON of New Mexico, Mr. SHIMKUS, and Mrs. BLACKBURN) introduced the following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To amend title XIX of the Social Security Act to provide 

public access to quality medical imaging procedures and 

radiation therapy procedures. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Consumer Assurance 

5 of Radiologic Excellence Act’’. 
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1 SEC. 2. STATE LICENSES REGARDING PRACTITIONERS OF 

2 MEDICAL IMAGING AND RADIATION THER3 APY; LIMITATION ON MEDICAID PAYMENTS 

4 FOR PROCEDURES. 

5 Title XIX of the Social Security Act (42 U.S.C. 1396 

6 et seq.) is amended— 

7 (1) in section 1903(i) (42 U.S.C. 1396b(i))— 

8 (A) in paragraph (20), by striking the pe9 riod at the end and inserting ‘‘; or’’; and 

10 (B) by inserting after paragraph (20) the 

11 following paragraph: 

12 ‘‘(21) with respect to any amount expended on 

13 medical imaging procedures or radiation therapy 

14 procedures unless the State meets the requirements 

15 of section 1930A (relating to State medical radiation 

16 licenses).’’; and 

17 (2) by inserting after section 1930 the following 

18 section: 

19 ‘‘STATE MEDICAL RADIATION LICENSES

20 ‘‘SEC. 1930A. (a) STATE LICENSES REGARDING

21 MEDICAL IMAGING AND RADIATION THERAPY.—For pur22 poses of section 1903(i)(21), a State meets the require23 ments of this section if the State demonstrates to the sat24 isfaction of the Secretary that the law of the State has 

25 in effect the following policies: 
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1 ‘‘(1) Subject to paragraphs (2) and (3), it is 

2 unlawful for an individual in the State to inten3 tionally administer or plan medical imaging proce4 dures or radiation therapy procedures to or for a pa5 tient for medical or chiropractic purposes unless the 

6 individual has obtained from the State a license, cer7 tificate, or other document that authorizes the indi8 vidual to administer such procedures in the State 

9 (referred to in this section as a ‘medical radiation li10 cense’). 

11 ‘‘(2) Notwithstanding any other provision of 

12 this section, the State deems an individual as hold13 ing a medical radiation license if the individual is li14 censed in the State as a doctor of medicine, osteop15 athy, dentistry, podiatry, or chiropractic. 

16 ‘‘(3) The State requires an individual who ad17 ministers or plans medical imaging procedures or ra18 diation therapy procedures to obtain a medical radi19 ation license from the State, unless— 

20 ‘‘(A) the individual exclusively performs 

21 medical ultrasound or echocardiography; or 

22 ‘‘(B) the individual is a student enrolled in 

23 an educational institution or program that is 

24 accredited pursuant to subsection (b)(2)(B) 

25 and, as a student, intentionally administers 
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1 medical imaging procedures or radiation ther2 apy procedures for medical or chiropractic pur3 poses under the supervision of an individual 

4 who holds a medical radiation license obtained 

5 from the State. 

6 ‘‘(4) The State does not provide a medical radi7 ation license to an individual unless the individual 

8 meets— 

9 ‘‘(A) the criteria established under sub10 section (b) by the Secretary; and 

11 ‘‘(B) such additional criteria as the State 

12 may establish. 

13 ‘‘(b) ISSUANCE BY SECRETARY OF MINIMUM LICENS14 ING CRITERIA.— 

15 ‘‘(1) IN GENERAL.—Not later than 18 months 

16 after the date of the enactment of the Consumer As17 surance of Radiologic Excellence Act, the Secretary 

18 shall by regulation issue criteria that, for purposes 

19 of subsection (a)(4)(A), establish the minimum 

20 standards for an individual to obtain a medical radi21 ation license from a State. In carrying out the pre22 ceding sentence, the Secretary shall— 

23 ‘‘(A) establish such standards as the Sec24 retary determines to be appropriate for ensur25 ing the quality performance of medical imaging 
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1 procedures and radiation therapy procedures; 

2 and 

3 ‘‘(B) ensure that the standards are at least 

4 as protective of the public health as standards 

5 issued under the Consumer-Patient Radiation 

6 Health and Safety Act of 1981. 

7 ‘‘(2) CERTAIN STANDARDS.—The Secretary 

8 shall ensure that standards under paragraph (1) are 

9 in accordance with the following: 

10 ‘‘(A) The standards shall specify the edu11 cational requirements for an individual to ob12 tain a medical radiation license, including, if 

13 applicable, requirements regarding practical ex14 perience. 

15 ‘‘(B) The standards shall provide that an 

16 educational requirement under subparagraph 

17 (A) is that the education involved be provided 

18 by an educational institution or program that is 

19 accredited by a nonprofit private entity recog20 nized by the Secretary for purposes of this sub21 section. 

22 ‘‘(C) The standards shall specify the cri23 teria that an entity is required to meet in order 

24 to be recognized by the Secretary as an accred25 iting entity under subparagraph (B). Such cri-
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1 teria shall provide that an entity will not be so 

2 recognized unless the entity establishes accred3 iting criteria satisfactory to the Secretary with 

4 respect to the quality of educational institutions 

5 and programs in the areas of administrative 

6 policies and procedures, curricula, record7 keeping, faculty, administrative support, and 

8 such other areas as the Secretary determines to 

9 be appropriate. 

10 ‘‘(3) CONSULTATION.—In developing standards 

11 under paragraph (1), the Secretary shall consult 

12 with organizations that are nationally recognized for 

13 their expertise in education and credentialing in 

14 medical imaging procedures and radiation therapy 

15 procedures. 

16 ‘‘(c) DEFINITIONS.—For purposes of this section: 

17 ‘‘(1) The term ‘administer’, with respect to 

18 medical imaging procedures or radiation therapy 

19 procedures, means— 

20 ‘‘(A) the act of directly exposing a patient 

21 to radiation via ionizing or RF radiation for 

22 purposes of medical imaging or for purposes of 

23 radiation therapy; and 

24 ‘‘(B) the act of positioning a patient to re25 ceive such an exposure. 
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1 ‘‘(2) The term ‘medical imaging procedure’ 

2 means any procedure or article, excluding medical 

3 ultrasound procedures or articles, intended for use 

4 in the diagnosis of disease or other medical or chiro5 practic conditions in humans, including diagnostic 

6 X-rays, nuclear medicine, and magnetic resonance 

7 procedures. 

8 ‘‘(3) The term ‘medical radiation license’ has 

9 the meaning indicated for such term in subsection 

10 (a)(1). 

11 ‘‘(4) The term ‘plan’, with respect to medical 

12 imaging procedures or radiation therapy procedures, 

13 means the act of preparing for the administering of 

14 such a procedure to a patient by evaluating patient15 specific or site-specific information, based on com16 puter analysis or direct measurement of dose, in 

17 order to customize the procedure for the patient and 

18 verifying appropriate dose administrations. 

19 ‘‘(5) The term ‘radiation therapy procedure’ 

20 means any radiation procedure or article intended 

21 for the cure, mitigation, or prevention of diseases or 

22 disorders in humans.’’. 
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1 SEC. 3. APPLICABILITY. 

2 With respect to the condition described in paragraph 

3 (21) of section 1903(i) of the Social Security Act (as in4 serted by section 2 of this Act): 

5 (1) Except as provided in paragraph (2), such 

6 condition applies to the States on and after the first 

7 day of the first calendar quarter that begins after 

8 the date on which the Secretary of Health and 

9 Human Services promulgates the final rule under 

10 section 1930A(b)(1) of the Social Security Act (as 

11 added by section 2 of this Act). 

12 (2) If the Secretary determines that meeting 

13 such condition requires State legislation (other than 

14 legislation appropriating funds), the condition ap15 plies to the State involved on and after the first day 

16 of the first calendar quarter that begins after the 

17 close of the relevant session of the State legislature. 

18 For purposes of the preceding sentence: 

19 (A) The relevant session is the first reg20 ular session of the State legislature that begins 

21 after the date on which such final rule is pro22 mulgated by the Secretary, subject to subpara23 graph (B). 

24 (B) If the State has a two-year legislative 

25 session, each year of the session is deemed to 
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1 be a separate regular session of the State legis2 lature for purposes of subparagraph (A). 

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