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

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118th CONGRESS
  2d Session
                                H. R. 485

_______________________________________________________________________

                                 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:

                                                                 Clerk.
118th CONGRESS

  2d Session

                               H. R. 485

_______________________________________________________________________

                                 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.
```