The "Access to Pediatric Technologies Act of 2025" aims to improve access to medical devices for children by establishing a process for setting payment rates for new pediatric technologies under Medicare.
John Joyce
Representative
PA-13
The "Access to Pediatric Technologies Act of 2025" aims to improve access to medical devices for children by requiring the establishment of national relative value units for qualifying pediatric technologies under Medicare. This ensures that manufacturers can request these units to be established using existing payment methodologies, facilitating appropriate valuation and payment for these specialized devices. The Act does not mandate coverage of any specific technology but streamlines the process for establishing payment rates, thereby encouraging innovation and availability of pediatric medical devices.
New Bill Streamlines Payments for Kids' Medical Devices, Boosts Access Starting 2026
The "Access to Pediatric Technologies Act of 2025" aims to get specialized medical devices into the hands of kids who need them, faster and more efficiently. It's all about making sure that when doctors say a child needs a specific device, it's actually available and affordable.
Making Pediatric Tech a Priority
This bill tackles a key issue in healthcare: the often-overlooked world of pediatric medical devices. It amends Section 1848 of the Social Security Act, focusing on how these devices are priced and paid for within the system. The core change? The government must set standard payment rates (called "national relative value units") for new "qualifying pediatric technologies" starting January 1, 2026 (SEC. 2). This is a big deal because it creates a clear, predictable payment pathway, encouraging companies to develop and market these life-changing devices.
Nuts and Bolts: How It Works
Think of it like this: If a company creates a new device specifically designed for kids (and it's approved by the FDA), they can ask the government to set a standard payment rate for it. The Secretary of Health and Human Services then uses existing payment methods and data to figure out that rate (SEC. 2). This means doctors and hospitals know what to expect, and companies have a clear incentive to innovate.
For example, imagine a new, smaller feeding tube designed specifically for premature babies. Under this bill, the manufacturer could request a standard payment rate, making it easier for hospitals to budget for and provide this crucial device to their tiniest patients.
There's a timeline, too. If a company submits its request by May 1st of any year, the payment rate gets set during that year's rulemaking process. After May 1st, it rolls over to the next year (SEC. 2). This keeps things moving and prevents endless delays.
Real-World Impact
This isn't just about paperwork; it's about real kids and real families. By streamlining the payment process, this bill could mean:
- Faster access: Kids get the devices they need sooner.
- More innovation: Companies are more likely to invest in developing new pediatric devices.
- Greater affordability: Standardized payments can help control costs.
It is important to note that this bill doesn't automatically mean every new device will be covered by insurance. That's still up to individual plans. But it does create a clearer, fairer system for pricing and paying for these essential technologies (SEC. 2).
Potential Roadblocks
While the bill's intent is good, there are potential challenges. Some worry that companies might try to label devices as "pediatric" even if they're widely used for adults, just to get the new payment rates. The definition of "qualifying pediatric technology" is pretty broad, and that could lead to some disagreements down the road (SEC. 2). Also, the yearly rulemaking process can be slow and sometimes gets tangled up in politics.
Overall, the Access to Pediatric Technologies Act of 2025 is a significant step toward improving healthcare for children. It addresses a real need and creates a system that could make a big difference in the lives of many families.