[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 485 Referred in Senate (RFS)]
<DOC>
118th CONGRESS
2d Session
H. R. 485
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
February 8 (legislative day, February 7), 2024
Received; read twice and referred to the Committee on Finance
_______________________________________________________________________
AN ACT
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.
SEC. 3. PREVENTION AND PUBLIC HEALTH FUND.
Section 4002(b) of the Patient Protection and Affordable Care Act
(42 U.S.C. 300u-11) is amended by striking paragraphs (7), (8), and (9)
and inserting the following:
``(7) for each of fiscal years 2024 and 2025,
$1,102,000,000;
``(8) for each of fiscal years 2026 and 2027,
$1,327,000,000;
``(9) for each of fiscal years 2028 and 2029,
$1,526,000,000; and''.
SEC. 4. REPORT.
Not later than 1 year after the date of the enactment of this Act,
and annually thereafter, the Comptroller General of the United States
shall submit to Congress a report on how quality-adjusted life years
negatively impacts individuals with intellectual and developmental
disabilities and their access to care.
Passed the House of Representatives February 7, 2024.
Attest:
KEVIN F. MCCUMBER,
Clerk.