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) in-
troduced the following bill; which was referred to the Committee on En-
ergy 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Consumer Assurance 
of Radiologic Excellence Act’’.
SEC. 2. STATE LICENSES REGARDING PRACTITIONERS OF 
MEDICAL IMAGING AND RADIATION THER-
APY; LIMITATION ON MEDICAID PAYMENTS 
FOR PROCEDURES. 
Title XIX of the Social Security Act (42 U.S.C. 1396 
et seq.) is amended— 
(1) in section 1903(i) (42 U.S.C. 1396b(i))— 
(A) in paragraph (20), by striking the pe-
riod at the end and inserting ‘‘; or’’; and 
(B) by inserting after paragraph (20) the 
following paragraph: 
‘‘(21) with respect to any amount expended on 
medical imaging procedures or radiation therapy 
procedures unless the State meets the requirements 
of section 1930A (relating to State medical radiation 
licenses).’’; and 
(2) by inserting after section 1930 the following 
section: 
‘‘STATE MEDICAL RADIATION LICENSES 
‘‘SEC. 1930A. (a) STATE LICENSES REGARDING 
MEDICAL IMAGING AND RADIATION THERAPY.—For pur-
poses of section 1903(i)(21), a State meets the require-
ments of this section if the State demonstrates to the sat-
isfaction of the Secretary that the law of the State has 
in effect the following policies:
‘‘(1) Subject to paragraphs (2) and (3), it is 
unlawful for an individual in the State to inten-
tionally administer or plan medical imaging proce-
dures or radiation therapy procedures to or for a pa-
tient for medical or chiropractic purposes unless the 
individual has obtained from the State a license, cer-
tificate, or other document that authorizes the indi-
vidual to administer such procedures in the State 
(referred to in this section as a ‘medical radiation li-
cense’). 
‘‘(2) Notwithstanding any other provision of 
this section, the State deems an individual as hold-
ing a medical radiation license if the individual is li-
censed in the State as a doctor of medicine, osteop-
athy, dentistry, podiatry, or chiropractic. 
‘‘(3) The State requires an individual who ad-
ministers or plans medical imaging procedures or ra-
diation therapy procedures to obtain a medical radi-
ation license from the State, unless— 
‘‘(A) the individual exclusively performs 
medical ultrasound or echocardiography; or 
‘‘(B) the individual is a student enrolled in 
an educational institution or program that is 
accredited pursuant to subsection (b)(2)(B) 
and, as a student, intentionally administers
medical imaging procedures or radiation ther-
apy procedures for medical or chiropractic pur-
poses under the supervision of an individual 
who holds a medical radiation license obtained 
from the State. 
‘‘(4) The State does not provide a medical radi-
ation license to an individual unless the individual 
meets— 
‘‘(A) the criteria established under sub-
section (b) by the Secretary; and 
‘‘(B) such additional criteria as the State 
may establish. 
‘‘(b) ISSUANCE BY SECRETARY OF MINIMUM LICENS-
ING CRITERIA.— 
‘‘(1) IN GENERAL.—Not later than 18 months 
after the date of the enactment of the Consumer As-
surance of Radiologic Excellence Act, the Secretary 
shall by regulation issue criteria that, for purposes 
of subsection (a)(4)(A), establish the minimum 
standards for an individual to obtain a medical radi-
ation license from a State. In carrying out the pre-
ceding sentence, the Secretary shall— 
‘‘(A) establish such standards as the Sec-
retary determines to be appropriate for ensur-
ing the quality performance of medical imaging
procedures and radiation therapy procedures; 
and 
‘‘(B) ensure that the standards are at least 
as protective of the public health as standards 
issued under the Consumer-Patient Radiation 
Health and Safety Act of 1981. 
‘‘(2) CERTAIN
STANDARDS.—The Secretary 
shall ensure that standards under paragraph (1) are 
in accordance with the following: 
‘‘(A) The standards shall specify the edu-
cational requirements for an individual to ob-
tain a medical radiation license, including, if 
applicable, requirements regarding practical ex-
perience. 
‘‘(B) The standards shall provide that an 
educational requirement under subparagraph 
(A) is that the education involved be provided 
by an educational institution or program that is 
accredited by a nonprofit private entity recog-
nized by the Secretary for purposes of this sub-
section. 
‘‘(C) The standards shall specify the cri-
teria that an entity is required to meet in order 
to be recognized by the Secretary as an accred-
iting entity under subparagraph (B). Such cri-
teria shall provide that an entity will not be so 
recognized unless the entity establishes accred-
iting criteria satisfactory to the Secretary with 
respect to the quality of educational institutions 
and programs in the areas of administrative 
policies and procedures, curricula, record-
keeping, faculty, administrative support, and 
such other areas as the Secretary determines to 
be appropriate. 
‘‘(3) CONSULTATION.—In developing standards 
under paragraph (1), the Secretary shall consult 
with organizations that are nationally recognized for 
their expertise in education and credentialing in 
medical imaging procedures and radiation therapy 
procedures. 
‘‘(c) DEFINITIONS.—For purposes of this section: 
‘‘(1) The term ‘administer’, with respect to 
medical imaging procedures or radiation therapy 
procedures, means— 
‘‘(A) the act of directly exposing a patient 
to radiation via ionizing or RF radiation for 
purposes of medical imaging or for purposes of 
radiation therapy; and 
‘‘(B) the act of positioning a patient to re-
ceive such an exposure.
‘‘(2) The term ‘medical imaging procedure’ 
means any procedure or article, excluding medical 
ultrasound procedures or articles, intended for use 
in the diagnosis of disease or other medical or chiro-
practic conditions in humans, including diagnostic 
X-rays, nuclear medicine, and magnetic resonance 
procedures. 
‘‘(3) The term ‘medical radiation license’ has 
the meaning indicated for such term in subsection 
(a)(1). 
‘‘(4) The term ‘plan’, with respect to medical 
imaging procedures or radiation therapy procedures, 
means the act of preparing for the administering of 
such a procedure to a patient by evaluating patient- 
specific or site-specific information, based on com-
puter analysis or direct measurement of dose, in 
order to customize the procedure for the patient and 
verifying appropriate dose administrations. 
‘‘(5) The term ‘radiation therapy procedure’ 
means any radiation procedure or article intended 
for the cure, mitigation, or prevention of diseases or 
disorders in humans.’’.
SEC. 3. APPLICABILITY. 
With respect to the condition described in paragraph 
(21) of section 1903(i) of the Social Security Act (as in-
serted by section 2 of this Act): 
(1) Except as provided in paragraph (2), such 
condition applies to the States on and after the first 
day of the first calendar quarter that begins after 
the date on which the Secretary of Health and 
Human Services promulgates the final rule under 
section 1930A(b)(1) of the Social Security Act (as 
added by section 2 of this Act). 
(2) If the Secretary determines that meeting 
such condition requires State legislation (other than 
legislation appropriating funds), the condition ap-
plies to the State involved on and after the first day 
of the first calendar quarter that begins after the 
close of the relevant session of the State legislature. 
For purposes of the preceding sentence: 
(A) The relevant session is the first reg-
ular session of the State legislature that begins 
after the date on which such final rule is pro-
mulgated by the Secretary, subject to subpara-
graph (B). 
(B) If the State has a two-year legislative 
session, each year of the session is deemed to
be a separate regular session of the State legis-
lature for purposes of subparagraph (A). 
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