Overview
Title
To amend title XVIII of the Social Security Act to facilitate patient access to certain pediatric technologies.
ELI5 AI
The bill wants to make it easier for kids to get special medical devices by creating a way to decide how much money should be paid for them in a fair way. It sets rules for how these devices can get priced, but it also says not all devices are guaranteed to be paid for.
Summary AI
The bill H. R. 1931, titled the "Access to Pediatric Technologies Act of 2025," aims to amend the Social Security Act to improve access to medical devices designed for children. It requires the Secretary of Health to establish payment rates for pediatric medical devices that are covered under Medicare and meet specific criteria, such as being approved by the Food and Drug Administration and used in procedures primarily for children. Manufacturers must submit requests for these devices to receive designated payment rates. The bill does not guarantee coverage for any device but sets up a framework for establishing payment values.
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AnalysisAI
General Summary of the Bill
House Resolution 1931, titled the "Access to Pediatric Technologies Act of 2025," was introduced on March 6, 2025, in the United States House of Representatives. The main goal of this bill is to amend title XVIII of the Social Security Act to facilitate patient access to certain pediatric technologies. The bill outlines how the Secretary of Health shall establish national relative value units for pediatric medical devices, which fall under specific criteria, to be included in the physician fee schedule. This process is intended to begin on January 1, 2026, and aims to streamline reimbursement processes for these technologies, ensuring they are more accessible to healthcare providers treating pediatric patients.
Summary of Significant Issues
A few notable issues arise from the bill's provisions. First, while requiring the Secretary to determine payment values, the bill does not include mechanisms to verify the data provided by manufacturers. This lack of verification could lead to inflated values that do not accurately reflect the true costs of the devices. Second, the bill requires that technologies have a temporary Level I HCPCS Code to be considered qualifying pediatric technologies. This requirement could exclude emerging or innovative devices lacking such a code, potentially stifling innovation.
Additionally, the assumption that manufacturers will provide comprehensive data like contractor pricing and claims data could prove problematic, as not all companies might have easy access to this information. Furthermore, there's an inherent contradiction within the bill as it states that nothing should be construed to require coverage, yet it emphasizes the importance of establishing payment values, leading to potential confusion about the reimbursement of these technologies. Lastly, the timeline for submitting requests to the Secretary might cause procedural delays, particularly concerning the speed at which new technologies are considered.
Impact on the Public
The bill's intent to facilitate access to pediatric medical technologies is beneficial in principle, potentially leading to improved healthcare outcomes for children by ensuring that critical medical devices are more readily available. However, the issues highlighted could impede this outcome. If the lack of verification leads to inflated device pricing, costs could unnecessarily increase for families and healthcare providers. Restricted access to innovative technologies due to coding requirements could also slow down the introduction of beneficial treatments.
Impact on Specific Stakeholders
Healthcare Providers and Patients: The positive impact on healthcare providers and patients would hinge on the bill's ability to properly streamline the reimbursement process, potentially making it easier for providers to offer advanced pediatric care. However, delays in including technologies in the fee schedule could mean slower access to the latest treatments for pediatric patients.
Manufacturers of Pediatric Technologies: For manufacturers, the bill offers a mechanism to secure payment values, which could encourage the production of devices specifically designed for pediatric use. Yet, limitations related to coding and data submission requirements might deter smaller companies without large-scale operational resources.
Regulatory and Administrative Bodies: For bodies like the Department of Health, the bill creates new procedural responsibilities that may increase administrative tasks, particularly concerning data verification and fee schedule amendments. Without clear guidelines, these tasks could introduce complexities and delays in implementation.
Conclusion
While H.R. 1931 carries the potential to improve the accessibility of pediatric technologies within the healthcare system, its success will largely depend on addressing the identified procedural and logistical issues. Balancing efficient implementation with effective oversight will be critical to ensure the bill can truly realize its goal of enhancing healthcare access for pediatric patients.
Issues
The bill requires the Secretary to establish national relative value units for qualifying pediatric technology upon manufacturer request, but it does not specify a mechanism for verifying the accuracy or validity of the data provided by the manufacturers, which could lead to inflated values. (Section 2)
The definition of 'qualifying pediatric technology' includes a requirement for a temporary Level I HCPCS Code, which might limit new or innovative technologies that don't meet this specific coding criterion, potentially stifling innovation. (Section 2)
The language assumes that the manufacturers will have access to and provide all the necessary data such as contractor pricing information, claims data, time and motion studies, and invoice information, which might not always be available. (Section 2)
The clause 'Nothing in this subsection shall be construed to require coverage of a qualifying pediatric technology' seems contradictory to the rest of the section which emphasizes establishing value units for such technologies, creating potential confusion as to whether or not these technologies will actually be reimbursed. (Section 2)
The timing of when the manufacturer’s request is received (on or before/after May 1) determines the speed at which the technology is considered for the fee schedule. This timeline may create delays in the availability of new pediatric technologies, potentially affecting patient care. (Section 2)
Sections
Sections are presented as they are annotated in the original legislative text. Any missing headers, numbers, or non-consecutive order is due to the original text.
1. Short title Read Opens in new tab
Summary AI
SECTION 1 gives the official name of the Act, which is "Access to Pediatric Technologies Act of 2025."
2. Facilitating access to pediatric technologies Read Opens in new tab
Summary AI
The text introduces changes to the Social Security Act that facilitate easier access to pediatric medical devices. Starting from January 1, 2026, manufacturers can request that the Secretary of Health establish specific payment values for these devices under the physician fee schedule, using various data like claims and pricing information, provided the devices meet certain criteria such as being approved for pediatric use and covered under existing healthcare laws.