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 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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HR 485 RFS

1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Protecting Health Care 

3 for All Patients Act of 2023’’. 

4 SEC. 2. PROHIBITING THE USE OF QUALITY-ADJUSTED 

5 LIFE YEARS AND SIMILAR MEASURES IN COV6 ERAGE AND PAYMENT DETERMINATIONS 

7 UNDER FEDERAL HEALTH CARE PROGRAMS. 

8 (a) IN GENERAL.—Section 1182(e) of the Social Se9 curity Act (42 U.S.C. 1320e–1(e)) is amended— 

10 (1) by inserting ‘‘or treats extending the life of 

11 an elderly, disabled, or terminally ill individual as of 

12 lower value than extending the life of an individual 

13 who is younger, non-disabled, or not terminally ill’’ 

14 after ‘‘because of an individual’s disability’’; 

15 (2) by inserting ‘‘described in the preceding 

16 sentence’’ after ‘‘such a similar measure’’; 

17 (3) by striking ‘‘The Secretary shall not’’ and 

18 inserting ‘‘A Federal agency (including the CMI (as 

19 described in section 1115A)) or State may not’’; 

20 (4) by striking ‘‘under title XVIII.’’ and insert21 ing the following: ‘‘under any Federal health care 

22 program (as defined in section 1128B, except that 

23 such term shall include the health program estab24 lished under chapter 89 of title 5, United States 

25 Code).’’; and 


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HR 485 RFS

1 (5) by adding at the end the following new sen2 tence: ‘‘Notwithstanding any other provision of law, 

3 a Federal agency (including the CMI) or State may 

4 not waive the application of the provisions of this 

5 subsection (or the provisions of section 1852(o), sec6 tion 1860D–12(h), section 1902(a)(88), section 

7 1932(b)(9), or section 2102(e)) under section 1115, 

8 section 1115A, or any other demonstration or waiver 

9 authority.’’. 

10 (b) CONFORMING AMENDMENTS.— 

11 (1) MEDICAID.— 

12 (A) IN GENERAL.—Section 1902(a) of the 

13 Social Security Act (42 U.S.C. 1396a(a)) is 

14 amended— 

15 (i) in paragraph (86), by striking 

16 ‘‘and’’ at the end; 

17 (ii) in paragraph (87)(D), by striking 

18 the period and inserting ‘‘; and’’; and 

19 (iii) by inserting after paragraph (87) 

20 the following new paragraph: 

21 ‘‘(88) provide for compliance with the require22 ments of section 1182(e) (relating to prohibiting the 

23 use of certain measures in coverage determinations, 

24 reimbursement, and incentive programs).’’. 


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HR 485 RFS

1 (B) MANAGED CARE ORGANIZATIONS.— 

2 Section 1932(b) of the Social Security Act (42 

3 U.S.C. 1396u–2(b)) is amended by adding at 

4 the end the following new paragraph: 

5 ‘‘(9) PROHIBITION ON USE OF QUALITY-AD6 JUSTED LIFE YEARS.—The provisions of section 

7 1182(e) shall apply to the utilization of a dollars8 per-quality adjusted life year or similar measure (as 

9 described in such section) by a medicaid managed 

10 care organization under this title (or a prepaid inpa11 tient health plan or prepaid ambulatory health plan, 

12 as defined in section 438.2 of title 42, Code of Fed13 eral Regulations (or any successor regulation), under 

14 a contract with the State) in the same manner as 

15 such provisions apply to the utilization of such a 

16 year or measure by a State under this title.’’. 

17 (2) CHIP.—Section 2102 of the Social Security 

18 Act (42 U.S.C. 1397bb) is amended by adding at 

19 the end the following new subsection: 

20 ‘‘(e) PROHIBITION ON THE USE OF QUALITY-AD21 JUSTED LIFE YEARS AND SIMILAR MEASURES.—A State 

22 child health plan shall provide for compliance with the re23 quirements of section 1182(e) (relating to prohibiting the 

24 use of certain measures in coverage determinations, reim25 bursement, and incentive programs).’’. 


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1 (3) MEDICARE ADVANTAGE.—Section 1852 of 

2 the Social Security Act (42 U.S.C. 1395w–22) is 

3 amended by adding at the end the following new 

4 subsection: 

5 ‘‘(o) PROHIBITION ON USE OF QUALITY-ADJUSTED

6 LIFE YEARS.—The provisions of section 1182(e) shall 

7 apply to the utilization of a dollars-per-quality adjusted 

8 life year or similar measure (as described in such section) 

9 by an MA plan in the same manner as such provisions 

10 apply to the utilization of such a year or measure by the 

11 Secretary under this title.’’. 

12 (4) MEDICARE 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 

15 subsection: 

16 ‘‘(h) PROHIBITION ON USE OF QUALITY-ADJUSTED

17 LIFE YEARS.—The provisions of section 1182(e) shall 

18 apply to the utilization of a dollars-per-quality adjusted 

19 life year or similar measure (as described in such section) 

20 by a prescription drug plan in the same manner as such 

21 provisions apply to the utilization of such a year or meas22 ure by the Secretary under this title.’’. 

23 (c) IMPLEMENTATION.—The amendments made by 

24 this section shall apply beginning on January 1, 2025. 


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1 SEC. 3. PREVENTION AND PUBLIC HEALTH FUND. 

2 Section 4002(b) of the Patient Protection and Af3 fordable Care Act (42 U.S.C. 300u–11) is amended by 

4 striking paragraphs (7), (8), and (9) and inserting the fol5 lowing: 

6 ‘‘(7) for each of fiscal years 2024 and 2025, 

7 $1,102,000,000; 

8 ‘‘(8) for each of fiscal years 2026 and 2027, 

9 $1,327,000,000; 

10 ‘‘(9) for each of fiscal years 2028 and 2029, 

11 $1,526,000,000; and’’. 

12 SEC. 4. REPORT. 

13 Not later than 1 year after the date of the enactment 

14 of this Act, and annually thereafter, the Comptroller Gen15 eral of the United States shall submit to Congress a report 

16 on how quality-adjusted life years negatively impacts indi17 viduals with intellectual and developmental disabilities and 

18 their access to care. 

Passed the House of Representatives February 7, 

2024. 

Attest: KEVIN F. MCCUMBER, 

Clerk. 


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