Protecting Health Care for All Patients Act of 2023
What changed between versions
The prohibition was expanded from 'The Secretary shall not' acting 'under title XVIII' (Medicare only) to 'A Federal agency or State may not' acting 'under any Federal health care program' as defined in section 1128B, which covers Medicare, Medicaid, CHIP, and other federal programs.
The CMI (Centers for Medicare & Medicaid Innovation) is now explicitly named as a covered entity, closing a potential gap where innovation center activities might have been excluded.
New conforming amendments extend the QALY prohibition to Medicaid managed care organizations (section 1932(b)(9)), Medicare Advantage plans (section 1852(o)), and Medicare Part D prescription drug plans (section 1860D-12(h)).
New explicit language prohibits treating '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,' making the anti-discrimination intent clearer.
A new anti-waiver provision (paragraph 5) states that no federal agency or state may waive the QALY prohibition under section 1115, 1115A, or any other demonstration or waiver authority, preventing states from opting out through Medicaid waivers.
A new reporting requirement directs the Comptroller General (GAO) to submit an annual report on how quality-adjusted life years negatively impact individuals with intellectual and developmental disabilities and their access to care.
A new implementation provision sets the effective date as January 1, 2025.
The Prevention and Public Health Fund is amended with specific funding levels: $1.102 billion for FY 2024-2025, $1.327 billion for FY 2026-2027, and $1.526 billion for FY 2028-2029.
The detailed pricing language about entities developing prices based on adjusted life years and using averages or other metrics was removed and replaced with the simpler phrase 'described in the preceding sentence,' relying on the new explicit prohibition language instead.
