Bill Details
HR.1931 - 119th Congress
Status
Latest action
2025-03-06 - Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced Date
2025-03-06
Policy Area
Health
Committees
View committees (2)
Sponsors
Cosponsors
View cosponsors (16)
- Rep. Trahan, Lori [D-Massachusetts-3]
- Rep. Elfreth, Sarah [D-Maryland-3]
- Rep. Veasey, Marc A. [D-Texas-33]
- Rep. Davis, Donald G. [D-North Carolina-1]
- Rep. Kustoff, David [R-Tennessee-8]
- Rep. Auchincloss, Jake [D-Massachusetts-4]
- Rep. Crenshaw, Dan [R-Texas-2]
- Rep. Craig, Angie [D-Minnesota-2]
- Rep. Moulton, Seth [D-Massachusetts-6]
- Rep. Schrier, Kim [D-Washington-8]
- Rep. Cohen, Steve [D-Tennessee-9]
- Rep. Harshbarger, Diana [R-Tennessee-1]
- Rep. Miller-Meeks, Mariannette [R-Iowa-1]
- Rep. Bresnahan, Robert P. [R-Pennsylvania-8]
- Rep. Goldman, Craig A. [R-Texas-12]
- Rep. Vindman, Eugene Simon [D-Virginia-7]
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AI Summary This summary was generated by AI from the bill text. AI can get information wrong.
This bill would make it easier for some pediatric medical devices to be paid for under Medicare’s doctor payment system. Starting January 1, 2026, if a device meets the bill’s definition of a “qualifying pediatric technology,” the Health and Human Services Secretary would have to set national payment values for it when the device’s manufacturer asks for it. The goal is to help newer child-focused technologies get recognized in the Medicare payment schedule using available pricing and use data, which could make payment decisions clearer and faster. The bill does not require Medicare to cover any device, and it does not change the rules for what Medicare can or cannot cover.
- The bill applies to certain medical devices that are already covered by Medicare and have been approved, cleared, or authorized by the FDA.
- To qualify, the device must have a temporary Level I HCPCS code and either be used mainly in procedures for children or be specially designed for safe and effective use in pediatric patients.
- Manufacturers would need to send a written request and include information that helps prove the device qualifies and helps set payment values, such as pricing, claims data, study data, or invoices if available.
- If the request is received by May 1, the payment values would be set in that year’s rulemaking process; if it comes after May 1, the values would be set the following year.
Official Summaries
Access to Pediatric Technologies Act of 2025
This 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.
Current Full Text
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1931 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 1931
To amend title XVIII of the Social Security Act to facilitate patient
access to certain pediatric technologies.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 6, 2025
Mr. Joyce of Pennsylvania (for himself and Mrs. Trahan) introduced the
following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committee on Ways and Means, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to facilitate patient
access to certain pediatric technologies.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Access to Pediatric Technologies Act
of 2025''.
SEC. 2. FACILITATING ACCESS TO PEDIATRIC TECHNOLOGIES.
(a) In General.--Section 1848 of the Social Security Act (42 U.S.C.
1395w-4) is amended by adding at the end the following new subsection:
``(u) Facilitating Access to Pediatric Technologies.--
``(1) In general.--For each qualifying pediatric technology
(as defined in paragraph (4)) furnished on or after January 1,
2026, the Secretary shall, upon receipt of a manufacturer
request under paragraph (3), establish national relative value
units under the physician fee schedule established under this
section, to the extent no such national relative value units
have been established for such qualifying pediatric technology
under such fee schedule.
``(2) Payment methodology.--The Secretary shall establish
national relative value units for a qualifying pediatric
technology under this subsection--
``(A) in accordance with the payment methodology
established under this section and applicable
regulations; and
``(B) using available data related to the
qualifying pediatric technology, which may include
applicable contractor pricing information, claims data,
time and motion studies, invoice information, or other
information used by the Secretary in establishing
payment rates.
``(3) Implementation.--
``(A) In general.--Upon written request to the
Secretary from the manufacturer of a qualifying
pediatric technology, the Secretary shall establish
national relative value units under paragraph (1)
through the annual rulemaking process for the physician
fee schedule established under this section, in
accordance with the timeline described in subparagraph
(B).
``(B) Timeline.--
``(i) In the case where the Secretary
receives a request under this paragraph on or
before May 1 of a given year from a
manufacturer with respect to a qualifying
pediatric technology of the manufacturer, the
Secretary shall establish national relative
value units for the qualifying pediatric
technology in the rulemaking process during
that year for the physician fee schedule
established under this section.
``(ii) In the case where the Secretary
receives a request under this paragraph after
May 1 of a given year from a manufacturer with
respect to a qualifying pediatric technology of
the manufacturer, the Secretary shall establish
national relative value units for the
qualifying pediatric technology in the
rulemaking process during the following year
for the physician fee schedule established
under this section.
``(C) Content of manufacturer requests.--A
manufacturer submitting a request under paragraph with
respect to a qualifying pediatric technology of the
manufacturer shall include in such request information
to verify that the technology is a qualifying pediatric
technology and to allow the Secretary to establish
national relative value units for such technology,
including (to the extent available) contractor pricing
information, claims data, time and motion studies,
invoice information, or other relevant information.
``(4) Qualifying pediatric technology defined.--In this
subsection, the term `qualifying pediatric technology' means a
medical device that is--
``(A) covered under this title;
``(B) approved, cleared, or authorized under
section 510(k), 513(f)(2), or 515 of the Federal Food,
Drug, and Cosmetic Act (21 U.S.C. 360(k), 360c(f)(2),
360e);
``(C) described by a temporary Level I HCPCS Code
intended for emerging technologies, services, or
procedures; and
``(D)(i) used as part of a procedure predominantly
performed on pediatric patients; or
``(ii) has otherwise been specifically designed for
safe and effective use in pediatric populations.
``(5) Rule of construction.--Nothing in this subsection
shall be construed to require coverage of a qualifying
pediatric technology under this title or alter the requirements
of section 1862(a)(1)(A).''.
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