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.
Impact
The implementation of SB249 is poised to positively impact the pediatric healthcare landscape by ensuring that essential technologies receive appropriate financial backing from healthcare systems. By establishing a clear and achievable process for determining relative value units, the bill aims to clarify and improve the mechanism by which new pediatric technologies are reimbursed, likely leading to increased availability of these innovations to healthcare providers and ultimately benefiting child patients.
Summary
Senate Bill 249, titled the 'Access to Pediatric Technologies Act of 2025', is designed to enhance access to pediatric technologies by amending title XVIII of the Social Security Act. The primary focus of the bill is to create a more streamlined reimbursement process for manufacturers of pediatric medical devices. This is achieved by establishing national relative value units for qualifying pediatric technologies, thereby determining fair payment rates under the physician fee schedule for these devices, which are expected to foster innovation and improvements in pediatric healthcare.
Contention
Discussion surrounding SB249 may revolve around potential concerns regarding the extent of government involvement in the reimbursement processes for medical technologies. Some stakeholders may worry about how the definitions and regulations set forth in this legislation might affect market dynamics, competition among device manufacturers, and the overall quality of pediatric care. Concerns may also arise regarding the possible reduction in flexibility for providers in choosing the most suitable technologies for their patients, as reimbursement rates become more standardized.
Maintaining Innovation and Safe Technologies ActThis bill requires the Centers for Medicare & Medicaid Services (CMS) to issue guidance on payment requirements for certain remote monitoring devices (e.g., glucose monitors) under Medicare medical services. Specifically, the CMS must issue guidance on payment requirements for devices that use artificial intelligence components and that transmit information to health care providers.
Urges American Academy of Pediatrics and New Jersey Chapter of American Academy of Pediatrics to issue guidance for pediatricians and family doctors on discussing personal space and privacy with children.
Kids' Access to Primary Care Act of 2025This bill modifies payments for Medicaid primary care services. Specifically, the bill applies a Medicare payment rate floor to Medicaid primary care services that are provided after the date of enactment of the bill and extends the payment rate to additional types of practitioners (e.g., obstetricians).The Centers for Medicare & Medicaid Services must conduct a study on the number of children enrolled in Medicaid, the number of providers receiving payment for primary care services, and associated payment rates before and after the bill's implementation.
Requires the EOHHS to amend the state Medicaid plan and secure sufficient state general revenue to increase Medicaid payment rates to an amount equal to one hundred thirty percent (130%) of Medicare rates for outpatient clinical pediatric services.
Requires the EOHHS to amend the state Medicaid plan and secure sufficient state general revenue to increase Medicaid payment rates to an amount equal to one hundred thirty percent (130%) of Medicare rates for outpatient clinical pediatric services.