I 
113TH CONGRESS 
1ST SESSION H. R. 1146 
To amend the Public Health Service Act and title XVIII of the Social 
Security Act to make the provision of technical services for medical 
imaging examinations and radiation therapy treatments safer, more accu-
rate, and less costly. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 13, 2013 
Mr. WHITFIELD (for himself, Mr. BARROW of Georgia, and Ms. SCHWARTZ) 
introduced the following bill; which was referred to the Committee on En-
ergy and Commerce, and in addition to the Committee on Ways and 
Means, for a period to be subsequently determined by the Speaker, in 
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned 
A BILL 
To amend the Public Health Service Act and title XVIII 
of the Social Security Act to make the provision of 
technical services for medical imaging examinations and 
radiation therapy treatments safer, more accurate, and 
less costly. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Consistency, Accuracy, 
Responsibility, and Excellence in Medical Imaging and 
Radiation Therapy Act of 2013’’. 
SEC. 2. PURPOSE. 
The purpose of this Act is to improve the quality and 
value of health care by increasing the safety and accuracy 
of medical imaging examinations and radiation therapy 
procedures, thereby reducing duplication of services and 
decreasing costs. 
SEC. 3. QUALITY OF MEDICAL IMAGING AND RADIATION 
THERAPY. 
Part F of title III of the Public Health Service Act 
(42 U.S.C. 262 et seq.) is amended by adding at the end 
the following: 
‘‘Subpart 4—Medical Imaging and Radiation Therapy 
‘‘SEC. 355. QUALITY OF MEDICAL IMAGING AND RADIATION 
THERAPY. 
‘‘(a) QUALIFIED PERSONNEL.— 
‘‘(1) IN GENERAL.—Effective 42 months after 
the date of enactment of this section, personnel who 
furnish the technical component of either medical 
imaging examinations or radiation therapy proce-
dures for medical purposes (except exempt individ-
uals as described in paragraph (4)) shall be fully 
qualified under this section to furnish such services. 
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‘‘(2) QUALIFICATIONS.—Individuals qualified to 
furnish the technical component of medical imaging 
examinations 
or 
radiation 
therapy 
procedures 
shall— 
‘‘(A) possess current certification in the 
medical imaging or radiation therapy modality 
or service they furnish from a certification or-
ganization designated under subsection (b); or 
‘‘(B) possess current State licensure or 
certification, where— 
‘‘(i) such services and modalities are 
within the scope of practice as defined by 
the State for such profession; and 
‘‘(ii) the requirements for licensure, 
certification, or registration meet or exceed 
the standards established by the certifi-
cation organization designated under sub-
section (b). 
‘‘(3) STATE
LICENSURE, CERTIFICATION, OR 
REGISTRATION.— 
‘‘(A) IN GENERAL.—Nothing in this sec-
tion shall be construed to diminish the author-
ity of a State to define requirements for licen-
sure, certification, or registration, the require-
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ments for practice, or the scope of practice of 
personnel. 
‘‘(B) LIMITATION.—The Secretary shall 
not take any action under this section that 
would require licensure by a State of personnel 
who furnish the technical component of medical 
imaging examinations or radiation therapy pro-
cedures. 
‘‘(4) EXEMPTIONS.— 
‘‘(A) 
IN
GENERAL.—The 
qualification 
standards described in this subsection and the 
payment provisions in section 1848(b)(4)(E) of 
the Social Security Act shall not apply to physi-
cians (as defined in section 1861(r) of the So-
cial Security Act (42 U.S.C. 1395x(r))) or to 
nurse practitioners and physician assistants 
(each as defined in section 1861(aa)(5) of the 
Social Security Act (42 U.S.C. 1395x(aa)(5))). 
Such practitioners shall not be included under 
the terms ‘personnel’ or ‘qualified personnel’ for 
purposes of this section. 
‘‘(B) 
INDIVIDUALS
CURRENTLY
EN-
ROLLED.—Individuals currently enrolled in a 
nuclear medicine, radiation therapy, or medical 
physicist training or certification program as of 
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the date the Secretary publishes the list of ap-
proved certification organizations shall have 6 
months from the date of completion of the 
training program to become fully qualified as 
required under subsection (a). 
‘‘(b) DESIGNATION OF CERTIFICATION ORGANIZA-
TIONS.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish a program for designating medical imaging or 
radiation therapy certification organizations that the 
Secretary determines have established appropriate 
procedures and programs for certifying personnel as 
qualified to furnish medical imaging or radiation 
therapy services. In establishing such program, the 
Secretary shall consult with professional organiza-
tions and recognized experts in the technical compo-
nent of medical imaging and radiation therapy serv-
ices. 
‘‘(2) FACTORS.— 
‘‘(A) IN GENERAL.—When designating cer-
tification organizations under this subsection, 
and when reviewing or modifying the list of des-
ignated organizations for the purposes of para-
graph (4)(B), the Secretary— 
‘‘(i) shall consider— 
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‘‘(I) whether the certification or-
ganization has established a process 
for the timely integration of new med-
ical imaging or radiation therapy serv-
ices into the organization’s certifi-
cation program; 
‘‘(II) whether the certification or-
ganization has established education 
and continuing education require-
ments for individuals certified by the 
organization; 
‘‘(III) whether the certification 
organization is a nonprofit organiza-
tion; 
‘‘(IV) whether the certification 
organization requires completion of a 
certification examination as a pre-
requisite for certification; and 
‘‘(V) whether the certification or-
ganization has been accredited by an 
accrediting body (as defined in sub-
paragraph (B)) that is approved by 
the Secretary; and 
‘‘(ii) may consider— 
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‘‘(I) whether the certification or-
ganization has established reasonable 
fees to be charged to those applying 
for certification; and 
‘‘(II) the ability of the certifi-
cation organization to review applica-
tions for certification in a timely man-
ner. 
‘‘(B) ACCREDITING BODY.—For purposes 
of this section, the term ‘accrediting body’ 
means an organization that— 
‘‘(i) is a nonprofit organization; 
‘‘(ii) is a national or international or-
ganization with accreditation programs for 
examinations leading to certification by 
certification organizations; and 
‘‘(iii) has established standards for 
recordkeeping and to minimize the possi-
bility of conflicts of interest. 
‘‘(3) EQUIVALENT EDUCATION, TRAINING, AND 
EXPERIENCE.— 
‘‘(A) IN GENERAL.—For purposes of this 
section, the Secretary shall, through regulation, 
provide a process for individuals whose training 
or experience are determined to be equal to, or 
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in excess of, those of a graduate of an accred-
ited educational program in that specialty to 
demonstrate their experience meets the edu-
cational standards for qualified personnel in 
their imaging modality or radiation therapy 
procedures. Such process may include docu-
mentation of items such as— 
‘‘(i) years and type of experience; 
‘‘(ii) a list of settings where experi-
ence was obtained; and 
‘‘(iii) verification of experience by su-
pervising physicians or clinically qualified 
hospital personnel. 
‘‘(B) ELIGIBILITY.—The Secretary shall 
not recognize any individual as having met the 
educational standards applicable under this 
paragraph based on experience pursuant to the 
authority of subparagraph (A) unless such indi-
vidual was furnishing the technical component 
of medical imaging examinations or radiation 
therapy treatments prior to the date of enact-
ment of this section. 
‘‘(4) PROCESS.— 
‘‘(A) REGULATIONS.—Not later than 12 
months after the date of enactment of this sec-
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tion, the Secretary shall promulgate regulations 
for designating certification organizations pur-
suant to this subsection. 
‘‘(B) DESIGNATIONS AND LIST.—Not later 
than 18 months after the date of enactment of 
this section, the Secretary shall make deter-
minations regarding all certification organiza-
tions that have applied for designation pursuant 
to the regulations promulgated under subpara-
graph (A), and shall publish a list of all certifi-
cation organizations that have received a des-
ignation. 
‘‘(C) PERIODIC REVIEW AND REVISION.— 
The Secretary shall periodically review the list 
under subparagraph (B), taking into account 
the factors established under paragraph (2). 
After such review, the Secretary may, by regu-
lation, modify the list of certification organiza-
tions that have received such designation. 
‘‘(D) WITHDRAWAL
OF
APPROVAL.—The 
Secretary may withdraw the approval of a cer-
tification organization listed under subpara-
graph (B) if the Secretary determines that the 
body no longer meets the requirements of this 
subsection. 
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‘‘(E) CERTIFICATIONS PRIOR TO REMOVAL 
FROM LIST.—If the Secretary removes a certifi-
cation organization from the list of certification 
organizations designated under subparagraph 
(B), any individual who was certified by the 
certification organization during or before the 
period beginning on the date on which the cer-
tification organization was designated as a cer-
tification organization under such subpara-
graph, and ending 12 months from the date on 
which the certification organization is removed 
from such list, shall be considered to have been 
certified by a certification organization des-
ignated by the Secretary under such subpara-
graph for the remaining period that such cer-
tification is in effect. 
‘‘(c) ALTERNATIVE STANDARDS
FOR RURAL
AND 
UNDERSERVED AREAS.—The chief executive officer of a 
State may submit to the Secretary a statement declaring 
that the requirements described in subsection (a) are inap-
propriate for application for medical imaging examinations 
or radiation therapy procedures that are furnished in a 
geographic area that is determined to be a ‘rural area’ 
(as such term is defined for purposes of section 
1886(d)(2)(D) of the Social Security Act) or that is des-
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ignated as a health professional shortage area (as defined 
in section 332 of this Act). Upon receipt of such state-
ment, if the Secretary deems it appropriate, the Secretary 
may waive the standards described in subsection (a) or 
develop alternative standards for such rural areas or 
health professional shortage areas. 
‘‘(d) RULE
OF CONSTRUCTION.—Notwithstanding 
any other provision of this section, individuals who provide 
medical imaging examinations relating to mammograms 
shall continue to meet the regulations applicable under the 
Mammography Quality Standards Act of 1992. 
‘‘(e) DEFINITION.—As used in this section: 
‘‘(1) MEDICAL
IMAGING.—The term ‘medical 
imaging’ means any examination or procedure used 
to visualize tissues, organs, or physiologic processes 
in humans for the purpose of detecting, diagnosing, 
treating, or impacting the progression of disease or 
illness. For purposes of this section, such term does 
not include routine dental or ophthalmologic diag-
nostic procedures or ultrasound guidance of vascular 
access procedures. 
‘‘(2) RADIATION
THERAPY.—The term ‘radi-
ation therapy’ means any procedure or article in-
tended for use in the cure, mitigation, treatment, or 
prevention of disease in humans that achieves its in-
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tended purpose through the emission of ionizing or 
non-ionizing radiation.’’. 
SEC. 4. STANDARDS FOR MEDICAL IMAGING AND RADI-
ATION THERAPY. 
Section 1848(b)(4) of the Social Security Act (42 
U.S.C. 1395w–4(b)(4)) is amended by adding at the end 
the following new subparagraph: 
‘‘(E) STANDARDS FOR MEDICAL IMAGING 
AND RADIATION THERAPY.—With respect to ex-
penses incurred in the furnishing of the tech-
nical component of medical imaging examina-
tions or radiation therapy procedures for med-
ical purposes (as defined in subsection (e) of 
section 355 of the Public Health Service Act) 
on or after 42 months after date of enactment 
of the Consistency, Accuracy, Responsibility, 
and Excellence in Medical Imaging and Radi-
ation Therapy Act of 2013, payment shall be 
made under this section only if the examination 
or procedure is furnished by an individual who 
meets the standards established by the Sec-
retary under such section 355 (other than an 
individual described in subsection (a)(4)(B)(i) 
of such section).’’. 
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SEC. 5. REPORT ON THE EFFECTS OF THIS ACT. 
(a) IN GENERAL.—Not later than 5 years after the 
date of enactment of this Act, the Secretary of Health and 
Human Services, shall submit to the Committee on 
Health, Education, Labor, and Pensions of the Senate, the 
Committee on Finance of the Senate, and the Committee 
on Energy and Commerce of the House of Representa-
tives, a report on the effects of this Act. 
(b) REQUIREMENTS.—The report under subsection 
(a) shall include the types and numbers of individuals 
qualified to furnish the technical component of medical im-
aging or radiation therapy services for whom standards 
have been developed, the impact of such standards on di-
agnostic accuracy and patient safety, and the availability 
and cost of services. Entities reimbursed for technical 
services through programs operating under the authority 
of the Secretary of Health and Human Services shall be 
required to contribute data to such report. 
Æ 
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