H.R. 6197: Health Tech Investment Act

This bill, known as the Health Tech Investment Act, aims to make changes to how certain healthcare services that utilize algorithms are reimbursed under the Medicare program. Here are its main points:

Revisions to Medicare Payment Structures

The bill proposes amendments to Section 1833(t) of the Social Security Act, specifically focusing on the payment for algorithm-based healthcare services under the Medicare program. The following changes are included:

• New Technology Ambulatory Payment Classification: The bill adds provisions to include specific algorithm-based healthcare services in a new payment classification. This classification aims to ensure that these services have appropriate reimbursement based on their costs.
• Manufacturer Cost Reporting: For algorithm-based services offered after January 1, 2026, manufacturers will need to submit detailed cost information to determine the payment classification. This includes various associated costs, such as invoice prices and overhead.
• Payment Security: Once a service is assigned a new payment classification, it cannot be removed until there is sufficient claims data, ensuring payments are stable for at least five years.

Eligibility Criteria Adjustments

The bill adjusts the criteria to expand the types of algorithm-based services eligible for reimbursement. This aims to recognize:

• Services that are distinctive and independently performed alongside other procedures.
• Algorithm-based services that are necessary due to additional resources needed during treatment or diagnosis.

Definition of Algorithm-Based Healthcare Service

The bill defines an algorithm-based healthcare service as one delivered through FDA-approved devices that utilize artificial intelligence or machine learning. These services are designed to assist healthcare providers in diagnosing or treating conditions.

Software as a Service Reimbursement

The legislation also includes a provision to codify the payment policies for software as a service under Medicare. This applies retroactively to services provided on or after January 1, 2023, ensuring that such services are appropriately reimbursed under the existing payment system.

Summary of Implications

In summary, the Health Tech Investment Act seeks to enhance the reimbursement processes for advanced technology in healthcare, particularly focusing on algorithm-based services. It aims to facilitate the integration of technological advancements in health services while providing manufacturers with a clear structure for reimbursement based on actual costs.

Relevant Companies

• Apple Inc. (AAPL) - As a company involved in health technology through its health-related products and services, Apple may be impacted by changes in reimbursement policies for algorithm-based healthcare services.
• Moderna, Inc. (MRNA) - As a biotechnology company utilizing advanced technologies for healthcare solutions, changes to the reimbursement landscape could affect its service offerings.
• Intuitive Surgical, Inc. (ISRG) - As a leader in robotic-assisted surgical technology, it could see an impact on the reimbursement of algorithm-based surgical services.