I
118THCONGRESS
1
STSESSION 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 deter-
minations under Federal health care programs.
IN THE HOUSE OF REPRESENTATIVES
JANUARY24, 2023
Mrs. R
ODGERSof Washington (for herself, Mr. SMITHof Missouri, Mr.
W
ENSTRUP, 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 de-
termined 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 meas-
ures in coverage and payment determinations under Fed-
eral health care programs.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE. 3
This Act may be cited as the ‘‘Protecting Health Care 4
for All Patients Act of 2023’’. 5
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•HR 485 IH
SEC. 2. PROHIBITING THE USE OF QUALITY-ADJUSTED 1
LIFE YEARS AND SIMILAR MEASURES IN COV-2
ERAGE AND PAYMENT DETERMINATIONS 3
UNDER FEDERAL HEALTH CARE PROGRAMS. 4
(a) I
NGENERAL.—Section 1182(e) of the Social Se-5
curity Act (42 U.S.C. 1320e–1(e)) is amended— 6
(1) by striking ‘‘The Secretary shall not’’ and 7
inserting ‘‘A Federal agency or State may not’’; 8
(2) by inserting ‘‘, including by using a price 9
developed by any entity or government that is based 10
on such an adjusted life year (or such a similar 11
measure) or using averages or other pricing metrics 12
that directly or indirectly take into account such 13
prices,’’ after ‘‘(or such a similar measure)’’; and 14
(3) by striking ‘‘under title XVIII.’’ and insert-15
ing the following: ‘‘under any Federal health care 16
program (as defined in section 1128B, except that 17
such term shall include the health program estab-18
lished under chapter 89 of title 5, United States 19
Code).’’. 20
(b) C
ONFORMINGAMENDMENTS.— 21
(1) M
EDICAID.—Section 1902(a) of the Social 22
Security Act (42 U.S.C. 1396a(a)) is amended— 23
(A) in paragraph (86), by striking ‘‘and’’ 24
at the end; 25
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•HR 485 IH
(B) in paragraph (87)(D), by striking the 1
period and inserting ‘‘; and’’; and 2
(C) by inserting after paragraph (87) the 3
following new paragraph: 4
‘‘(88) provide for compliance with the require-5
ments of section 1182(e) (relating to prohibiting the 6
use of certain measures in coverage determinations, 7
reimbursement, and incentive programs).’’. 8
(2) CHIP.—Section 2102 of the Social Security 9
Act (42 U.S.C. 1397bb) is amended by adding at 10
the end the following new subsection: 11
‘‘(d) P
ROHIBITION ON THE USE OFQUALITY-AD-12
JUSTEDLIFEYEARS ANDSIMILARMEASURES.—A State 13
child health plan shall provide for compliance with the re-14
quirements of section 1182(e) (relating to prohibiting the 15
use of certain measures in coverage determinations, reim-16
bursement, and incentive programs).’’. 17
Æ
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