I 

118TH CONGRESS 

1ST SESSION H. R. 485 

To amend title XI of the Social Security Act to prohibit the use of qualityadjusted life years and similar measures in coverage and payment determinations under Federal health care programs. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 24, 2023 

Mrs. RODGERS of Washington (for herself, Mr. SMITH of Missouri, Mr. 

WENSTRUP, 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 determined 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 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, 

3 SECTION 1. SHORT TITLE. 

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

5 for All Patients Act of 2023’’. 


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•HR 485 IH

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

2 LIFE YEARS AND SIMILAR MEASURES IN COV3 ERAGE AND PAYMENT DETERMINATIONS 

4 UNDER FEDERAL HEALTH CARE PROGRAMS. 

5 (a) IN GENERAL.—Section 1182(e) of the Social Se6 curity Act (42 U.S.C. 1320e–1(e)) is amended— 

7 (1) by striking ‘‘The Secretary shall not’’ and 

8 inserting ‘‘A Federal agency or State may not’’; 

9 (2) by inserting ‘‘, including by using a price 

10 developed by any entity or government that is based 

11 on such an adjusted life year (or such a similar 

12 measure) or using averages or other pricing metrics 

13 that directly or indirectly take into account such 

14 prices,’’ after ‘‘(or such a similar measure)’’; and 

15 (3) by striking ‘‘under title XVIII.’’ and insert16 ing the following: ‘‘under any Federal health care 

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

18 such term shall include the health program estab19 lished under chapter 89 of title 5, United States 

20 Code).’’. 

21 (b) CONFORMING AMENDMENTS.— 

22 (1) MEDICAID.—Section 1902(a) of the Social 

23 Security Act (42 U.S.C. 1396a(a)) is amended— 

24 (A) in paragraph (86), by striking ‘‘and’’ 

25 at the end; 


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•HR 485 IH

1 (B) in paragraph (87)(D), by striking the 

2 period and inserting ‘‘; and’’; and 

3 (C) by inserting after paragraph (87) the 

4 following new paragraph: 

5 ‘‘(88) provide for compliance with the require6 ments of section 1182(e) (relating to prohibiting the 

7 use of certain measures in coverage determinations, 

8 reimbursement, and incentive programs).’’. 

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

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

11 the end the following new subsection: 

12 ‘‘(d) PROHIBITION ON THE USE OF QUALITY-AD13 JUSTED LIFE YEARS AND SIMILAR MEASURES.—A State 

14 child health plan shall provide for compliance with the re15 quirements of section 1182(e) (relating to prohibiting the 

16 use of certain measures in coverage determinations, reim17 bursement, and incentive programs).’’. 

Æ 


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