118THCONGRESS
2
DSESSION H. R. 485
AN ACT
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 2
•HR 485 EH
SECTION 1. SHORT TITLE. 1
This Act may be cited as the ‘‘Protecting Health Care 2
for All Patients Act of 2023’’. 3
SEC. 2. PROHIBITING THE USE OF QUALITY-ADJUSTED 4
LIFE YEARS AND SIMILAR MEASURES IN COV-5
ERAGE AND PAYMENT DETERMINATIONS 6
UNDER FEDERAL HEALTH CARE PROGRAMS. 7
(a) I
NGENERAL.—Section 1182(e) of the Social Se-8
curity Act (42 U.S.C. 1320e–1(e)) is amended— 9
(1) by inserting ‘‘or treats extending the life of 10
an elderly, disabled, or terminally ill individual as of 11
lower value than extending the life of an individual 12
who is younger, non-disabled, or not terminally ill’’ 13
after ‘‘because of an individual’s disability’’; 14
(2) by inserting ‘‘described in the preceding 15
sentence’’ after ‘‘such a similar measure’’; 16
(3) by striking ‘‘The Secretary shall not’’ and 17
inserting ‘‘A Federal agency (including the CMI (as 18
described in section 1115A)) or State may not’’; 19
(4) by striking ‘‘under title XVIII.’’ and insert-20
ing the following: ‘‘under any Federal health care 21
program (as defined in section 1128B, except that 22
such term shall include the health program estab-23
lished under chapter 89 of title 5, United States 24
Code).’’; and 25 3
•HR 485 EH
(5) by adding at the end the following new sen-1
tence: ‘‘Notwithstanding any other provision of law, 2
a Federal agency (including the CMI) or State may 3
not waive the application of the provisions of this 4
subsection (or the provisions of section 1852(o), sec-5
tion 1860D–12(h), section 1902(a)(88), section 6
1932(b)(9), or section 2102(e)) under section 1115, 7
section 1115A, or any other demonstration or waiver 8
authority.’’. 9
(b) C
ONFORMINGAMENDMENTS.— 10
(1) M
EDICAID.— 11
(A) I
N GENERAL.—Section 1902(a) of the 12
Social Security Act (42 U.S.C. 1396a(a)) is 13
amended— 14
(i) in paragraph (86), by striking 15
‘‘and’’ at the end; 16
(ii) in paragraph (87)(D), by striking 17
the period and inserting ‘‘; and’’; and 18
(iii) by inserting after paragraph (87) 19
the following new paragraph: 20
‘‘(88) provide for compliance with the require-21
ments of section 1182(e) (relating to prohibiting the 22
use of certain measures in coverage determinations, 23
reimbursement, and incentive programs).’’. 24 4
•HR 485 EH
(B) MANAGED CARE ORGANIZATIONS .— 1
Section 1932(b) of the Social Security Act (42 2
U.S.C. 1396u–2(b)) is amended by adding at 3
the end the following new paragraph: 4
‘‘(9) P
ROHIBITION ON USE OF QUALITY -AD-5
JUSTED LIFE YEARS .—The provisions of section 6
1182(e) shall apply to the utilization of a dollars- 7
per-quality adjusted life year or similar measure (as 8
described in such section) by a medicaid managed 9
care organization under this title (or a prepaid inpa-10
tient health plan or prepaid ambulatory health plan, 11
as defined in section 438.2 of title 42, Code of Fed-12
eral Regulations (or any successor regulation), under 13
a contract with the State) in the same manner as 14
such provisions apply to the utilization of such a 15
year or measure by a State under this title.’’. 16
(2) CHIP.—Section 2102 of the Social Security 17
Act (42 U.S.C. 1397bb) is amended by adding at 18
the end the following new subsection: 19
‘‘(e) P
ROHIBITION ON THE USE OFQUALITY-AD-20
JUSTEDLIFEYEARS ANDSIMILARMEASURES.—A State 21
child health plan shall provide for compliance with the re-22
quirements of section 1182(e) (relating to prohibiting the 23
use of certain measures in coverage determinations, reim-24
bursement, and incentive programs).’’. 25 5
•HR 485 EH
(3) MEDICARE ADVANTAGE .—Section 1852 of 1
the Social Security Act (42 U.S.C. 1395w–22) is 2
amended by adding at the end the following new 3
subsection: 4
‘‘(o) P
ROHIBITION ONUSE OFQUALITY-ADJUSTED 5
L
IFEYEARS.—The provisions of section 1182(e) shall 6
apply to the utilization of a dollars-per-quality adjusted 7
life year or similar measure (as described in such section) 8
by an MA plan in the same manner as such provisions 9
apply to the utilization of such a year or measure by the 10
Secretary under this title.’’. 11
(4) M
EDICARE PART D.—Section 1860D–12 of 12
the Social Security Act (42 U.S.C. 1395w–112) is 13
amended by adding at the end the following new 14
subsection: 15
‘‘(h) P
ROHIBITION ONUSE OFQUALITY-ADJUSTED 16
L
IFEYEARS.—The provisions of section 1182(e) shall 17
apply to the utilization of a dollars-per-quality adjusted 18
life year or similar measure (as described in such section) 19
by a prescription drug plan in the same manner as such 20
provisions apply to the utilization of such a year or meas-21
ure by the Secretary under this title.’’. 22
(c) I
MPLEMENTATION.—The amendments made by 23
this section shall apply beginning on January 1, 2025. 24 6
•HR 485 EH
SEC. 3. PREVENTION AND PUBLIC HEALTH FUND. 1
Section 4002(b) of the Patient Protection and Af-2
fordable Care Act (42 U.S.C. 300u–11) is amended by 3
striking paragraphs (7), (8), and (9) and inserting the fol-4
lowing: 5
‘‘(7) for each of fiscal years 2024 and 2025, 6
$1,102,000,000; 7
‘‘(8) for each of fiscal years 2026 and 2027, 8
$1,327,000,000; 9
‘‘(9) for each of fiscal years 2028 and 2029, 10
$1,526,000,000; and’’. 11
SEC. 4. REPORT. 12
Not later than 1 year after the date of the enactment 13
of this Act, and annually thereafter, the Comptroller Gen-14
eral of the United States shall submit to Congress a report 15
on how quality-adjusted life years negatively impacts indi-16
viduals with intellectual and developmental disabilities and 17
their access to care. 18
Passed the House of Representatives February 7,
2024.
Attest:
Clerk. 118
TH
CONGRESS
2
D
S
ESSION
H. R. 485
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 deter-
minations under Federal health care programs.