[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