The bill is expected to significantly impact how pediatric technologies are assessed for reimbursement under Medicare. By providing a mechanism for manufacturers to request recognition and payment rates for their devices, the legislation is poised to facilitate a wider availability of these technologies to healthcare providers for pediatric patients, potentially improving treatment outcomes and patient care. Moreover, by ensuring that pediatric technologies receive coverage under Medicare, the law can lead to enhancements in pediatric care offerings and overall child health metrics in the United States.
Summary
SB5275, known as the Access to Pediatric Technologies Act of 2024, aims to amend the Social Security Act with the goal of enhancing patient access to certain pediatric technologies. The bill stipulates that starting from January 1, 2026, the Secretary of Health and Human Services will establish national relative value units for qualifying pediatric technologies based on requests from manufacturers, if such units have not already been established. This provision aims to streamline the payment process and ensure that pediatric technologies are adequately recognized within the healthcare system's payment structure.
Contention
Despite its objectives, SB5275 has faced some contention regarding the scope of 'qualifying pediatric technologies.' Critics argue that the criteria for what qualifies as a pediatric technology need to be clarified to prevent potential misuse or overreach by manufacturers seeking rapid reimbursement. Furthermore, concerns have been raised about the implications for healthcare costs, as establishing new payment rates may influence overall Medicare expenditures. Proponents of the bill counter that the potential benefits to child health and technology accessibility outweigh these concerns.
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)