H.R.1931 - Access to Pediatric Technologies Act of 2025 (119th Congress)
Summary
H.R.1931, the "Access to Pediatric Technologies Act of 2025," aims to amend Title XVIII of the Social Security Act to improve patient access to specific pediatric technologies. The bill directs the Secretary of Health and Human Services to establish national relative value units under the physician fee schedule for qualifying pediatric technologies. This would occur upon manufacturer request and would facilitate Medicare reimbursement for these technologies.
The bill defines "qualifying pediatric technology" as a medical device covered under Title XVIII, approved or cleared under relevant sections of the Federal Food, Drug, and Cosmetic Act, described by a temporary Level I HCPCS code, and used in procedures predominantly performed on pediatric patients or specifically designed for pediatric use.
The Act specifies a timeline for the Secretary to establish these relative value units, linking it to the annual rulemaking process for the physician fee schedule.
Expected Effects
The primary effect of this bill would be to streamline the process for establishing Medicare reimbursement rates for new pediatric medical devices. This could lead to increased availability of these technologies for children covered by Medicare. Ultimately, this could improve health outcomes for pediatric patients.
Potential Benefits
- Improved Access to Care: Facilitates quicker access to innovative pediatric technologies for children covered by Medicare.
- Incentivizes Innovation: Encourages manufacturers to develop new pediatric-specific medical devices by ensuring a pathway for Medicare reimbursement.
- Clarity and Predictability: Establishes a clear process and timeline for setting reimbursement rates, reducing uncertainty for manufacturers.
- Potential for Better Health Outcomes: By making advanced technologies more accessible, the bill could lead to improved health outcomes for pediatric patients.
- Addresses a Specific Need: Targets a vulnerable population (children) and addresses the unique challenges of developing and accessing pediatric medical technologies.
Potential Disadvantages
- Increased Medicare Spending: Establishing new reimbursement rates could increase overall Medicare spending.
- Administrative Burden: The Secretary of HHS will face an increased administrative burden in evaluating manufacturer requests and setting appropriate reimbursement rates.
- Potential for Abuse: Manufacturers might seek to classify devices as "pediatric technologies" to take advantage of the expedited reimbursement process, even if their primary use is not pediatric.
- Limited Scope: The bill only addresses Medicare reimbursement and does not address access issues for children covered by private insurance or Medicaid.
- Uncertainty in Actual Impact: The actual impact on access to care will depend on the specific reimbursement rates set by the Secretary and the responsiveness of manufacturers.
Constitutional Alignment
This bill appears to align with the general welfare clause of the Constitution, as it aims to improve healthcare access for children, potentially promoting their well-being. Specifically, the preamble states the Constitution is intended to "promote the general Welfare".
Congress's authority to legislate on matters related to Medicare stems from its power to tax and spend for the general welfare. The bill does not appear to infringe on any specific individual rights or liberties protected by the Constitution or its amendments.
However, the delegation of authority to the Secretary of Health and Human Services to establish reimbursement rates is a common practice and generally upheld as constitutional, provided there are sufficient guidelines and standards for the Secretary to follow, which this bill appears to provide.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).