Protecting Health Care for All Patients Act of 2023

Subjects: Health, Child health, Government employee pay, benefits, personnel management, Health care costs and insurance, Health care coverage and access, Medicaid, Poverty and welfare assistance, Veterans' medical care

Summary:  <p><b>Protecting Health Care for All Patients Act of </b><b>2023</b></p> <p>This bill prohibits all federal health care programs, including the Federal Employees Health Benefits Program, and federally funded state health care programs (e.g., Medicaid) from using prices that are based on quality-adjusted life years (i.e., measures that discount the value of a life based on disability) to determine relevant thresholds for coverage, reimbursements, or incentive programs.</p>

<html><body><pre>[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 485 Introduced in House (IH)]

&lt;DOC&gt;






118th CONGRESS
  1st Session
                                H. R. 485

  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

_______________________________________________________________________

                                 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 striking ``The Secretary shall not'' and inserting 
        ``A Federal agency or State may not'';
            (2) by inserting ``, including by using a price developed 
        by any entity or government that is based on such an adjusted 
        life year (or such a similar measure) or using averages or 
        other pricing metrics that directly or indirectly take into 
        account such prices,'' after ``(or such a similar measure)''; 
        and
            (3) 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).''.
    (b) Conforming Amendments.--
            (1) Medicaid.--Section 1902(a) of the Social Security Act 
        (42 U.S.C. 1396a(a)) is amended--
                    (A) in paragraph (86), by striking ``and'' at the 
                end;
                    (B) in paragraph (87)(D), by striking the period 
                and inserting ``; and''; and
                    (C) 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).''.
            (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:
    ``(d) 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).''.
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