H.R. 6197

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6197 Introduced in House (IH)]

<DOC>

119th CONGRESS
1st Session
H. R. 6197

To amend title XVIII of the Social Security Act to ensure appropriate 
payment of certain algorithm-based healthcare services under the 
Medicare program.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

November 20, 2025

Mr. Joyce of Pennsylvania (for himself, Mr. Peters, Ms. Van Duyne, Mr. 
Schneider, Mr. Obernolte, and Ms. Craig) 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 ensure appropriate 
payment of certain algorithm-based healthcare services under the 
Medicare program.

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 ``Health Tech Investment Act''.

SEC. 2. ENSURING APPROPRIATE PAYMENT OF CERTAIN ALGORITHM-BASED 
HEALTHCARE SERVICES UNDER THE MEDICARE PROGRAM.

(a) In General.--Section 1833(t) of the Social Security Act (42 
U.S.C. 1395l(t)) is amended--
(1) in paragraph (2)(E), by inserting ``and new technology 
ambulatory payment classification of algorithm-based healthcare 
services under paragraph (16)(H)'' after ``(16)(G)''; and
(2) in paragraph (16), by adding at the end the following 
new subparagraph:
``(H) Special rule for certain algorithm-based 
healthcare services.--
``(i) In general.--In the case of a covered 
OPD service furnished on or after January 1, 
2026, that is an algorithm-based healthcare 
service (as defined in clause (ii)) that is 
assigned to a new technology ambulatory payment 
classification (as described in the final rule 
entitled `Medicare Program; Changes to the 
Hospital Outpatient Prospective Payment System 
for Calendar Year 2002' published by the 
Department of Health and Human Services on 
November 30, 2001 (66 Fed. Reg. 59897)) on or 
after the date of the enactment of this 
subparagraph or for which, as of such date, is 
currently and has been assigned to a new 
technology ambulatory payment classification 
for a period of less than 5 years, the 
Secretary--
``(I) shall ensure that such 
service is assigned to a new technology 
ambulatory payment classification based 
on the cost of such service as 
submitted by the manufacturer of such 
service in a form and manner specified 
by the Secretary, including costs for 
the technology based on invoice prices, 
subscription-based prices, clinical 
staff, overhead, and other costs 
associated with providing the service;
``(II) shall adjust the new 
technology ambulatory payment 
classification pursuant to subclause 
(I) as necessary; and
``(III) may not remove such service 
from the new technology ambulatory 
payment classification as determined 
under subclauses (I) and (II) until the 
Secretary determines that adequate 
claims data exists to reassign such 
service to another ambulatory payment 
classification (which in no case may be 
before such service has received 
payment under the assigned new 
technology ambulatory payment 
classification for at least 5 years).
``(ii) Adjustment.--The Secretary shall 
adjust the application process and criteria for 
the new technology ambulatory payment 
classification to ensure that, in addition to 
currently eligible algorithm-based healthcare 
services, algorithm-based healthcare services 
that otherwise meet the eligibility 
requirements for such classification and are 
distinct from but performed concurrently with, 
adjunctive to, or provided in any other 
modality or form as part of an underlying 
service and require additional resources, 
meet--
``(I) the eligibility requirement 
that they are distinct new procedures 
with a beginning, middle, and end; or
``(II) any subsequent similar new 
technology ambulatory payment 
classification eligibility requirement.
``(iii) Definition of algorithm-based 
healthcare service.--For purposes of this 
subparagraph, the term `algorithm-based 
healthcare service' means a service delivered 
through a device cleared or approved by the 
Food and Drug Administration that uses 
artificial intelligence, machine learning, or 
other similarly designed software to yield 
clinical outputs or generate clinical 
conclusions for use by a physician or 
practitioner in the screening, detection, 
diagnosis, or treatment of an individual's 
condition or disease, or any such other similar 
service as the Secretary determines appropriate 
in consultation with appropriate 
organizations.''.
(b) Codifying OPPS Payment for Software as a Service.--Effective 
for services provided on or after January 1, 2023, the Secretary of 
Health and Human Services shall apply the hospital outpatient 
prospective payment system payment for software as a service policy 
described in the final rule entitled, ``Medicare Program: Hospital 
Outpatient Prospective Payment and Ambulatory Surgical Center Payment 
Systems and Quality Reporting Programs; Organ Acquisition; Rural 
Emergency Hospitals: Payment Policies, Conditions of Participation, 
Provider Enrollment, Physician Self-Referral; New Service Category for 
Hospital Outpatient Department Prior Authorization Process; Overall 
Hospital Quality Star Rating; COVID-19'' published by the Department of 
Health and Human Services on November 23, 2022 (87 Fed. Reg. 71748).
<all>