Protecting Health Care for All Patients Act of 2023

Bill: 118-hr-485
Sponsor: full_name: Rep. McMorris Rodgers, Cathy [R-WA-5]
Introduced: 2023-01-24
Policy area: Health
Subjects: 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
Latest action: action_date: 2024-12-17
text: Referred to the Subcommittee on Health.

Summaries:
action_date: 2023-01-24
action_desc: Introduced in House
text: <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>

action_date: 2023-05-17
action_desc: Reported to House, Part I
text: <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, age, or terminal illness) to determine relevant thresholds for coverage, reimbursements, or incentive programs.</p>

action_date: 2024-02-07
action_desc: Passed House
text: <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, age, or terminal illness) to determine relevant thresholds for coverage, reimbursements, or incentive programs.</p> <p>The Government Accountability Office must annually report on how the use of quality-adjusted life years negatively affects individuals with intellectual and developmental disabilities.</p> <p>The bill also reduces funding for the Prevention and Public Health Fund for FY2024-FY2029.</p>

tv_txt: IIB 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.

1. Short title This Act may be cited as the Protecting Health Care for All Patients Act of 2023 . 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. 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 . 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. Kevin F. McCumber, Clerk.

tv_txt: IB 118th CONGRESS 2d Session H. R. 485 IN THE HOUSE OF REPRESENTATIVES 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.

1. Short title This Act may be cited as the Protecting Health Care for All Patients Act of 2023 . 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. 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 . 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. Cheryl L. Johnson, Clerk.

tv_txt: IB Union Calendar No. 45 118th CONGRESS 1st Session H. R. 485 [Report No. 118–65, Part I] 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.

1. Short title This Act may be cited as the Protecting Health Care for All Patients Act of 2023 . 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.

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

tv_txt: I 118th CONGRESS 1st Session H. R. 485 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.

1. Short title This Act may be cited as the Protecting Health Care for All Patients Act of 2023 . 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). .