The legislation aims to address existing barriers that prevent pediatric devices from being effectively integrated into the healthcare delivery system. By requiring the establishment of national relative value units, the bill is expected to streamline the process by which healthcare providers can receive compensation for using such technologies. This could lead to improved access to advanced treatments for children, ensuring that pediatric patients receive care tailored to their specific needs.
Summary
House Bill 9157, titled the 'Access to Pediatric Technologies Act of 2024', seeks to amend Title XVIII of the Social Security Act to enhance patient access to certain pediatric technologies. The bill mandates that the Secretary of Health and Human Services establish national relative value units for qualifying pediatric technologies beginning January 1, 2026. This process is intended to facilitate the inclusion and reimbursement of innovative medical devices specifically designed for pediatric use within the healthcare system.
Contention
While supporters of HB 9157 argue that it is a step forward in modernizing pediatric healthcare, there are concerns regarding the implications for healthcare costs and the potential for increased spending in this sector. Critics may highlight that establishing new payment methodologies could lead to unintended consequences, such as increased financial burdens on the healthcare system or challenges in quickly adopting new technologies due to bureaucratic delays. The bill's impact on existing healthcare budget allocations and potential shifts in insurance policies also warrant further scrutiny.
Access to Pediatric Technologies Act of 2025This bill requires the Centers for Medicare & Medicaid Services (CMS) to establish, upon request, specific payment methodologies for qualifying pediatric technologies under the Medicare physician fee schedule. Qualifying pediatric technologies are medical devices that are (1) covered under Medicare, (2) approved by the Food and Drug Administration, (3) currently billed using a specified temporary billing code for emerging technologies, and (4) predominantly used or specifically designated for pediatric patients.The CMS must develop a payment methodology for a qualifying pediatric technology upon request from the manufacturer and based on available data, including pricing information and claims data. Manufacturers must include relevant information in their requests to enable the CMS to develop the corresponding methodologies.
Establishes the Information Technology Infrastructure Fee to be assessed on certain state transactions to support the state's information technology infrastructure (OR INCREASE SD RV See Note)