[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 485 Reported in House (RH)]

<DOC>





                                                  Union Calendar No. 45
118th CONGRESS
  1st Session
                                H. R. 485

                      [Report No. 118-65, Part I]

  To amend title XI of the Social Security Act to prohibit the use of 
   quality-adjusted life years and similar measures in coverage and 
       payment determinations under Federal health care programs.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            January 24, 2023

  Mrs. Rodgers of Washington (for herself, Mr. Smith of Missouri, Mr. 
  Wenstrup, and Mr. Burgess) 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

                              May 17, 2023

        Additional sponsors: Mr. Hern and Mr. Carter of Georgia

                              May 17, 2023

  Reported from the Committee on Energy and Commerce with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

                              May 17, 2023

 Committee on Ways and Means discharged; committed to the Committee of 
  the Whole House on the State of the Union and ordered to be printed
[For text of introduced bill, see copy of bill as introduced on January 
                               24, 2023]


_______________________________________________________________________

                                 A BILL


 
  To amend title XI of the Social Security Act to prohibit the use of 
   quality-adjusted life years and similar measures in coverage and 
       payment determinations under Federal health care programs.


 


    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 ``Protecting Health Care for All 
Patients Act of 2023''.

SEC. 2. PROHIBITING THE USE OF QUALITY-ADJUSTED LIFE YEARS AND SIMILAR 
              MEASURES IN COVERAGE AND PAYMENT DETERMINATIONS UNDER 
              FEDERAL HEALTH CARE PROGRAMS.

    (a) In General.--Section 1182(e) of the Social Security Act (42 
U.S.C. 1320e-1(e)) is amended--
            (1) by inserting ``or treats extending the life of an 
        elderly, disabled, or terminally ill individual as of lower 
        value than extending the life of an individual who is younger, 
        non-disabled, or not terminally ill'' after ``because of an 
        individual's disability'';
            (2) by inserting ``described in the preceding sentence'' 
        after ``such a similar measure'';
            (3) by striking ``The Secretary shall not'' and inserting 
        ``A Federal agency (including the CMI (as described in section 
        1115A)) or State may not'';
            (4) by striking ``under title XVIII.'' and inserting the 
        following: ``under any Federal health care program (as defined 
        in section 1128B, except that such term shall include the 
        health program established under chapter 89 of title 5, United 
        States Code).''; and
            (5) by adding at the end the following new sentence: 
        ``Notwithstanding any other provision of law, a Federal agency 
        (including the CMI) or State may not waive the application of 
        the provisions of this subsection (or the provisions of section 
        1852(o), section 1860D-12(h), section 1902(a)(88), section 
        1932(b)(9), or section 2102(e)) under section 1115, section 
        1115A, or any other demonstration or waiver authority.''.
    (b) Conforming Amendments.--
            (1) Medicaid.--
                    (A) In general.--Section 1902(a) of the Social 
                Security Act (42 U.S.C. 1396a(a)) is amended--
                            (i) in paragraph (86), by striking ``and'' 
                        at the end;
                            (ii) in paragraph (87)(D), by striking the 
                        period and inserting ``; and''; and
                            (iii) by inserting after paragraph (87) the 
                        following new paragraph:
            ``(88) provide for compliance with the requirements of 
        section 1182(e) (relating to prohibiting the use of certain 
        measures in coverage determinations, reimbursement, and 
        incentive programs).''.
                    (B) Managed care organizations.--Section 1932(b) of 
                the Social Security Act (42 U.S.C. 1396u-2(b)) is 
                amended by adding at the end the following new 
                paragraph:
            ``(9) Prohibition on use of quality-adjusted life years.--
        The provisions of section 1182(e) shall apply to the 
        utilization of a dollars-per-quality adjusted life year or 
        similar measure (as described in such section) by a medicaid 
        managed care organization under this title (or a prepaid 
        inpatient health plan or prepaid ambulatory health plan, as 
        defined in section 438.2 of title 42, Code of Federal 
        Regulations (or any successor regulation), under a contract 
        with the State) in the same manner as such provisions apply to 
        the utilization of such a year or measure by a State under this 
        title.''.
            (2) CHIP.--Section 2102 of the Social Security Act (42 
        U.S.C. 1397bb) is amended by adding at the end the following 
        new subsection:
    ``(e) Prohibition on the Use of Quality-Adjusted Life Years and 
Similar Measures.--A State child health plan shall provide for 
compliance with the requirements of section 1182(e) (relating to 
prohibiting the use of certain measures in coverage determinations, 
reimbursement, and incentive programs).''.
            (3) Medicare advantage.--Section 1852 of the Social 
        Security Act (42 U.S.C. 1395w-22) is amended by adding at the 
        end the following new subsection:
    ``(o) Prohibition on Use of Quality-adjusted Life Years.--The 
provisions of section 1182(e) shall apply to the utilization of a 
dollars-per-quality adjusted life year or similar measure (as described 
in such section) by an MA plan in the same manner as such provisions 
apply to the utilization of such a year or measure by the Secretary 
under this title.''.
            (4) Medicare part d.--Section 1860D-12 of the Social 
        Security Act (42 U.S.C. 1395w-112) is amended by adding at the 
        end the following new subsection:
    ``(h) Prohibition on Use of Quality-adjusted Life Years.--The 
provisions of section 1182(e) shall apply to the utilization of a 
dollars-per-quality adjusted life year or similar measure (as described 
in such section) by a prescription drug plan in the same manner as such 
provisions apply to the utilization of such a year or measure by the 
Secretary under this title.''.
    (c) Implementation.--The amendments made by this section shall 
apply beginning on January 1, 2025.
                                                  Union Calendar No. 45

118th CONGRESS

  1st Session

                               H. R. 485

                      [Report No. 118-65, Part I]

_______________________________________________________________________

                                 A BILL

  To amend title XI of the Social Security Act to prohibit the use of 
   quality-adjusted life years and similar measures in coverage and 
       payment determinations under Federal health care programs.

_______________________________________________________________________

                              May 17, 2023

  Reported from the Committee on Energy and Commerce with an amendment

                              May 17, 2023

 Committee on Ways and Means discharged; committed to the Committee of 
  the Whole House on the State of the Union and ordered to be printed