IB
Union Calendar No. 45
118THCONGRESS
1
STSESSION 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 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
M
AY17, 2023
Additional sponsors: Mr. H
ERNand Mr. CARTERof Georgia
M
AY17, 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]
MAY17, 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]
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•HR 485 RH
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.
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•HR 485 RH
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
SEC. 2. PROHIBITING THE USE OF QUALITY-ADJUSTED LIFE 6
YEARS AND SIMILAR MEASURES IN COV-7
ERAGE AND PAYMENT DETERMINATIONS 8
UNDER FEDERAL HEALTH CARE PROGRAMS. 9
(a) I
NGENERAL.—Section 1182(e) of the Social Secu-10
rity Act (42 U.S.C. 1320e–1(e)) is amended— 11
(1) by inserting ‘‘or treats extending the life of 12
an elderly, disabled, or terminally ill individual as of 13
lower value than extending the life of an individual 14
who is younger, non-disabled, or not terminally ill’’ 15
after ‘‘because of an individual’s disability’’; 16
(2) by inserting ‘‘described in the preceding sen-17
tence’’ after ‘‘such a similar measure’’; 18
(3) by striking ‘‘The Secretary shall not’’ and in-19
serting ‘‘A Federal agency (including the CMI (as de-20
scribed in section 1115A)) or State may not’’; 21
(4) by striking ‘‘under title XVIII.’’ and insert-22
ing the following: ‘‘under any Federal health care 23
program (as defined in section 1128B, except that 24
such term shall include the health program established 25
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•HR 485 RH
under chapter 89 of title 5, United States Code).’’; 1
and 2
(5) by adding at the end the following new sen-3
tence: ‘‘Notwithstanding any other provision of law, 4
a Federal agency (including the CMI) or State may 5
not waive the application of the provisions of this 6
subsection (or the provisions of section 1852(o), sec-7
tion 1860D–12(h), section 1902(a)(88), section 8
1932(b)(9), or section 2102(e)) under section 1115, 9
section 1115A, or any other demonstration or waiver 10
authority.’’. 11
(b) C
ONFORMINGAMENDMENTS.— 12
(1) M
EDICAID.— 13
(A) I
N GENERAL.—Section 1902(a) of the 14
Social Security Act (42 U.S.C. 1396a(a)) is 15
amended— 16
(i) in paragraph (86), by striking 17
‘‘and’’ at the end; 18
(ii) in paragraph (87)(D), by striking 19
the period and inserting ‘‘; and’’; and 20
(iii) by inserting after paragraph (87) 21
the following new paragraph: 22
‘‘(88) provide for compliance with the require-23
ments of section 1182(e) (relating to prohibiting the 24
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•HR 485 RH
use of certain measures in coverage determinations, 1
reimbursement, and incentive programs).’’. 2
(B) M
ANAGED CARE ORGANIZATIONS .—Sec-3
tion 1932(b) of the Social Security Act (42 4
U.S.C. 1396u–2(b)) is amended by adding at the 5
end the following new paragraph: 6
‘‘(9) P
ROHIBITION ON USE OF QUALITY -AD-7
JUSTED LIFE YEARS .—The provisions of section 8
1182(e) shall apply to the utilization of a dollars-per- 9
quality adjusted life year or similar measure (as de-10
scribed in such section) by a medicaid managed care 11
organization under this title (or a prepaid inpatient 12
health plan or prepaid ambulatory health plan, as de-13
fined in section 438.2 of title 42, Code of Federal Reg-14
ulations (or any successor regulation), under a con-15
tract with the State) in the same manner as such pro-16
visions apply to the utilization of such a year or 17
measure by a State under this title.’’. 18
(2) CHIP.—Section 2102 of the Social Security 19
Act (42 U.S.C. 1397bb) is amended by adding at the 20
end the following new subsection: 21
‘‘(e) P
ROHIBITION ON THE USE OFQUALITY-AD-22
JUSTEDLIFEYEARS ANDSIMILARMEASURES.—A State 23
child health plan shall provide for compliance with the re-24
quirements of section 1182(e) (relating to prohibiting the 25
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•HR 485 RH
use of certain measures in coverage determinations, reim-1
bursement, and incentive programs).’’. 2
(3) M
EDICARE ADVANTAGE.—Section 1852 of the 3
Social Security Act (42 U.S.C. 1395w–22) is amend-4
ed by adding at the end the following new subsection: 5
‘‘(o) P
ROHIBITION ONUSE OFQUALITY-ADJUSTED 6
L
IFEYEARS.—The provisions of section 1182(e) shall apply 7
to the utilization of a dollars-per-quality adjusted life year 8
or similar measure (as described in such section) by an MA 9
plan in the same manner as such provisions apply to the 10
utilization of such a year or measure by the Secretary 11
under this title.’’. 12
(4) M
EDICARE PART D.—Section 1860D–12 of 13
the Social Security Act (42 U.S.C. 1395w–112) is 14
amended by adding at the end the following new sub-15
section: 16
‘‘(h) P
ROHIBITION ONUSE OFQUALITY-ADJUSTED 17
L
IFEYEARS.—The provisions of section 1182(e) shall apply 18
to the utilization of a dollars-per-quality adjusted life year 19
or similar measure (as described in such section) by a pre-20
scription drug plan in the same manner as such provisions 21
apply to the utilization of such a year or measure by the 22
Secretary under this title.’’. 23
(c) I
MPLEMENTATION.—The amendments made by this 24
section shall apply beginning on January 1, 2025. 25
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pbinns on DSKJLVW7X2PROD with $$_JOB Union Calendar No.
45
118
TH
CONGRESS
1
ST
S
ESSION
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 deter-
minations under Federal health care programs.
M
AY
17, 2023
Reported from the Committee on Energy and Commerce
with an amendment
M
AY
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
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