ROOT Act
- Sponsor
- Rep. Harshbarger, Diana [R-TN-1]
- Committees
- Ways and Means Committee (primary)
- Last action
- Oct 10, 2025
Bottom line
The ROOT Act aims to streamline and refine Medicare's imaging appropriate use criteria program by centralizing data reporting with CDSMs and exempting specific services and small/rural practices, potentially reducing administrative burden for providers while maintaining oversight.
What it actually does
The bill, known as the ROOT Act, amends the Social Security Act to significantly revise the Appropriate Use Criteria (AUC) program for applicable imaging services under Medicare. It shifts the responsibility for collecting and reporting AUC consultation data from furnishing professionals to qualified clinical decision support mechanisms (CDSMs) and introduces new exemptions for certain services and practice types. The bill also redefines "outlier" ordering professionals as "low compliant" and mandates regular studies on compliance and utilization.
Proponents argue
Proponents argue that the current AUC program places an undue administrative burden on furnishing professionals, particularly in small and rural practices, without sufficient data collection efficiency. By shifting reporting to CDSMs and providing targeted exemptions, the bill will reduce red tape, improve program efficiency, and ensure that the AUC program focuses on its intended goal of reducing unnecessary imaging without hindering access to care, especially for preventive services or in underserved areas.
Opponents contend
Opponents might argue that shifting reporting responsibility away from furnishing professionals could dilute accountability or create new data integrity challenges. They might also contend that expanding exemptions, particularly for small and rural practices, could inadvertently create loopholes that undermine the effectiveness of the AUC program in controlling costs and ensuring appropriate care, potentially leading to an increase in unnecessary imaging in those exempted settings.
The bill is relatively short and clearly structured, making it accessible for an informed reader to understand its core changes within a reasonable timeframe.
Section 2(a)(1) and (2)(B)
Direct Reporting by Clinical Decision Support Mechanisms
This provision modifies the Social Security Act to require qualified clinical decision support mechanisms (CDSMs) to directly collect and report specific information about imaging orders to the Secretary of Health and Human Services (HHS), rather than requiring the furnishing professional to generate and provide certification. This change, effective January 1, 2026, centralizes data collection and aims to streamline the reporting process for appropriate use criteria (AUC) consultations.
Supporters argue
Supporters argue this change will significantly reduce the administrative burden on healthcare providers, particularly furnishing professionals, by centralizing data reporting with the CDSMs that are already consulted for imaging orders. This streamlines the process and allows providers to focus more on patient care.
Critics contend
Critics might express concern that shifting reporting responsibility entirely to CDSMs could introduce new complexities in data integration and oversight, potentially making it harder for the Secretary to ensure accurate and complete compliance data if CDSMs are not adequately equipped or incentivized.
Tradeoffs
This provision balances the goal of reducing provider administrative burden with the need for robust and accurate data collection to monitor the effectiveness of the AUC program.
Section 2(a)(2)(C)
Expansion of Exemptions for Specific Services and Practices
The bill introduces several new categories of exemptions from the appropriate use criteria (AUC) requirements for applicable imaging services. These include services ordered as part of clinical trials, services ordered by professionals in small practices (15 or fewer) or rural health professional shortage areas, and specific preventive/screening services like mammography, lung cancer CT screening, and colonography CT.
Section 2(a)(3)
Designation of Low Compliant Ordering Professionals
The bill renames "outlier ordering professionals" to "low compliant ordering professionals" and mandates that the Secretary annually determine the total number of such professionals. A "low compliant" professional is defined as one whose compliance rate (ratio of AUC-consulted orders to total orders, excluding exempted services) falls below a threshold determined by the Secretary.
Section 2(a)(4)
Periodic Study on AUC Compliance and Imaging Utilization
This section replaces the existing paragraph (6) with a new requirement for the Secretary to conduct a study every five years, starting January 1, 2031. The study must assess compliance rates, the impact of the AUC program on imaging utilization, and propose mechanisms for improving compliance, including potential prior authorization for low compliant professionals or payment adjustments.
Section 2(a)(5)
Adherence to Specialty Society Endorsement Process
This new paragraph (8) requires the Secretary, when specifying appropriate use criteria (AUC) and qualified clinical decision support mechanisms (CDSMs), to substantially adhere to the approach described in 42 CFR 414.94 as it existed on January 1, 2023. This regulation outlines the process for identifying and endorsing AUC developed by specialty societies.
The bill amends specific subsections of Section 1834(q) of the Social Security Act and mandates adherence to 42 CFR 414.94 for specifying AUC and CDSMs.
Section 2(a) and Section 2(a)(5)
Why it matters:This is standard legislative practice for amending existing law and referencing established regulatory processes. It is not evasive, but it does require specialized knowledge to fully understand the scope of changes.
Case for: Referencing existing law and regulation ensures that the new provisions integrate seamlessly into the established legal framework, maintaining consistency and avoiding unintended conflicts.
Case against: For a lay reader, these references make the bill less self-contained and harder to understand without external research, potentially obscuring the full scope of changes.
Estimated impact: Ensures the bill's changes are applied within the existing Medicare Part B framework for imaging services and that AUC development continues to follow a recognized, evidence-based process.