‘‘(ii) demonstrate that they can pro-
vide convenient access to such a tool via a 
secure web-based portal at no cost to— 
‘‘(I) suppliers and providers who 
order and furnish applicable advanced 
diagnostic imaging services under this 
title; and 
‘‘(II) the Federal government. 
‘‘(E) PERIODIC UPDATING.—The Secretary 
shall periodically update the list of qualified 
suppliers of approved electronic clinical decision 
support tools that meet the standards estab-
lished under subparagraph (B) and the other 
requirements of this paragraph. 
‘‘(4) CONSULTATION REQUIREMENT.—The Sec-
retary shall require that, as a condition of participa-
tion in the program under this title, suppliers and 
providers who order an applicable advanced diag-
nostic imaging service shall agree to consult an ap-
proved electronic clinical decision support tool listed 
pursuant to paragraph (3) in connection with such 
order. 
‘‘(5) PAYMENT
FOR
SERVICES
CONTINGENT 
UPON REGISTRY SUBMISSION.— 
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‘‘(A) IN GENERAL.—With respect to an ap-
plicable advanced diagnostic imaging service, 
payment for the technical or professional com-
ponent of such service under the fee schedule 
established under section 1848(b) or under the 
prospective payment system for hospital out-
patient department services under section 
1833(t) may only be made if the documentation 
accompanying any such claim for payment dem-
onstrates that an approved electronic clinical 
decision support tool listed pursuant to para-
graph (3) was consulted and the required infor-
mation was submitted to a registry qualified 
under paragraph (2). 
‘‘(B) DEMONSTRATION OF COMPLIANCE.— 
Compliance with the requirements under sub-
paragraph (A) may be demonstrated by the in-
clusion of a Clinical Decision Support Number 
with the claim for payment. 
‘‘(6) EXEMPTIONS.— 
‘‘(A) 
SIGNIFICANT
HARDSHIP
EXEMP-
TION.—The Secretary may, on a case-by-case 
basis, exempt a supplier or provider to whom 
this subsection would otherwise apply if the 
Secretary determines, subject to annual re-
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newal, that compliance with this subsection 
would result in a significant hardship, such as 
in the case of a supplier or provider who lacks 
access to an electronic records system or high- 
speed Internet access. 
‘‘(B) 
EMERGENCY
SERVICES
EXEMP-
TION.—Applicable advanced diagnostic imaging 
services ordered emergently as part of an emer-
gency medical evaluation shall not be subject to 
the requirements of this subsection. 
‘‘(C) CLARIFICATION OF INAPPLICABILITY 
TO INPATIENT SERVICES.—Advanced diagnostic 
imaging services ordered for inpatients and for 
which payment is made under part A are not 
subject to the requirements of this subsection. 
‘‘(7) LIMITATIONS.—The Secretary may not 
utilize the authority provided under this subsection 
to— 
‘‘(A) impose any requirement that a sup-
plier or provider obtain approval to order an 
advanced diagnostic imaging service before per-
forming such service or any other requirement 
for prior authorization with respect to such 
service; or 
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‘‘(B) use approved electronic clinical deci-
sion support tools to make claims payment de-
terminations under this title. 
‘‘(8) RULEMAKING REGARDING PATIENT SAFE-
TY.—The Secretary shall promulgate regulations to 
address situations in which a supplier or provider, 
prior to performing an applicable advanced diag-
nostic imaging service for an individual, reasonably 
believes that the service ordered, if performed, would 
pose a safety risk to the individual and that a dif-
ferent imaging service is more appropriate under the 
circumstances. Such regulations shall define cir-
cumstances in which the supplier or provider may 
change the order to an imaging service the supplier 
or provider determines is more appropriate.’’. 
(b) COMPLIANCE WITH APPROPRIATENESS REG-
ISTRY TREATED
AS SATISFACTORY QUALITY REPORT-
ING.—Section 1848(m)(3) of the Social Security Act (42 
U.S.C. 1395w–4(m)(3)) is amended— 
(1) by redesignating subparagraph (F) as sub-
paragraph (H); and 
(2) by inserting after subparagraph (E) the fol-
lowing new subparagraphs: 
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‘‘(F) SATISFACTORY
REPORTING
MEAS-
URES THROUGH PARTICIPATION IN IMAGING AP-
PROPRIATENESS REGISTRY.— 
‘‘(i) IN
GENERAL.—For 2015 and 
subsequent years, the Secretary shall treat 
an eligible professional described in clause 
(ii) as satisfactorily submitting data on 
quality measures under subparagraph (A) 
if, instead of reporting measures under 
subsection (k)(2)(C), the eligible profes-
sional provides evidence, in a form and 
manner specified by the Secretary, dem-
onstrating that the registry submission re-
quirements under section 1833(p)(5) have 
been complied with with respect to not less 
than 90 percent of claims for applicable 
advanced diagnostic imaging services (as 
defined in section 1833(p)(1)(B)) sub-
mitted by the eligible professional in the 
year. 
‘‘(ii) ELIGIBLE
PROFESSIONAL
DE-
SCRIBED.—For purposes of clause (i), an 
eligible professional described in this clause 
is an eligible professional who furnishes 
the technical or professional component of 
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applicable advanced diagnostic imaging 
services (as so defined). 
‘‘(G) SATISFACTORY
REPORTING
MEAS-
URES THROUGH PARTICIPATION IN IMAGING AP-
PROPRIATENESS REGISTRY.— 
‘‘(i) IN
GENERAL.—For 2015 and 
subsequent years, the Secretary shall treat 
an eligible professional described in clause 
(ii) as satisfactorily submitting data on 
quality measures under subparagraph (A) 
if, in lieu of reporting measures under sub-
section (k)(2)(C), the eligible professional 
provides evidence, in a form and manner 
specified by the Secretary, demonstrating 
that they have complied with the consulta-
tion requirements under section 1833(p)(4) 
with respect to not less than 90 percent of 
claims for applicable advanced diagnostic 
imaging services (as so defined) submitted 
by the eligible professional in the year. 
‘‘(ii) ELIGIBLE
PROFESSIONAL
DE-
SCRIBED.—For purposes of clause (i), an 
eligible professional described in this clause 
is an eligible professional who orders appli-
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cable advanced diagnostic imaging services 
(as so defined).’’. 
(c) 
CONFORMING
AMENDMENT.—Section 
1833(t)(16) of the Social Security Act (42 U.S.C. 
1395l(t)(16)) is amended by adding at the end the fol-
lowing new subparagraph: 
‘‘(E) APPLICATION OF APPROPRIATENESS 
REQUIREMENTS FOR CERTAIN ADVANCED DIAG-
NOSTIC IMAGING SERVICES.—For provisions re-
lating to the application of appropriateness re-
quirements for certain advanced diagnostic im-
aging services, see section 1834(p).’’. 
Æ 
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