The "Access to Pediatric Technologies Act of 2025" directs the Secretary to set national payment values for qualifying pediatric medical devices under the physician fee schedule, ensuring manufacturers can access appropriate reimbursement for these technologies. This aims to facilitate access to medical devices specifically designed or predominantly used for pediatric care, without mandating coverage.
Marsha Blackburn
Senator
TN
The "Access to Pediatric Technologies Act of 2025" aims to improve children's access to innovative medical devices by directing the Secretary to set national payment values for qualifying pediatric technologies under the physician fee schedule, starting in 2026. Manufacturers can request these payment values, providing necessary data to support the technology's pediatric qualification. This act is intended to facilitate access to these technologies without mandating coverage or altering existing requirements.
New Bill Could Boost Access to Specialized Medical Devices for Kids Starting 2026
The "Access to Pediatric Technologies Act of 2025" is all about making it easier for kids to get the specialized medical devices they need. The core of the bill is directing the Secretary (likely of Health and Human Services) to set standard payment rates, called "relative value units," for these devices under the physician fee schedule. This kicks in on January 1, 2026.
Making Medical Tech More Accessible
This bill tackles a key issue: sometimes, doctors hesitate to use specialized pediatric devices because the payment system isn't clear. By establishing these "relative value units," the government is essentially saying, "We recognize these devices are important, and here's how we'll value them for payment." This should make it more financially viable for doctors to use these technologies. Think of it like this: if a mechanic knows exactly how much they'll get paid for a specific repair, they're more likely to do it. It is the same concept here, but with children's medical devices.
To get these payment rates, manufacturers have to apply, providing data to prove their device qualifies. It has to be a device already approved by the FDA, have a specific temporary code (Level I HCPCS Code), and be primarily used for kids or specifically designed for them. If they apply by May 1st of each year, the request will be processed that year, after that date will be processed the following year. (SEC. 2).
Real-World Impact
Imagine a child with a rare condition needing a specialized device. Right now, their doctor might have to jump through hoops to figure out payment. This bill streamlines that process. For parents, this could mean quicker access to devices that improve their children's health. For pediatricians, it could mean less administrative hassle and more predictable payments. For manufacturers, it creates a clearer pathway to get their devices used, potentially boosting development of new pediatric tech.
The Fine Print: Coverage Not Guaranteed
It's important to note that this bill doesn't force insurance companies to cover these devices (SEC. 2). It simply sets the payment rates if they are covered. Also, there's a bit of wiggle room in the definition of "predominantly for pediatric procedures." This could lead to some back-and-forth about which devices actually qualify. One potential issue is that manufacturers might try to present data to get the highest possible payment rates, so there will need to be checks and balances in place.