IB 

Union Calendar No. 45 

118TH CONGRESS 

1ST SESSION H. R. 485 

[Report No. 118–65, Part I] 

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 

MAY 17, 2023 

Additional sponsors: Mr. HERN and Mr. CARTER of Georgia 

MAY 17, 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] 

MAY 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 

[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 measures in coverage and payment determinations under Federal health care programs. 


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•HR 485 RH

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’’. 

6 SEC. 2. PROHIBITING THE USE OF QUALITY-ADJUSTED LIFE 

7 YEARS AND SIMILAR MEASURES IN COV8 ERAGE AND PAYMENT DETERMINATIONS 

9 UNDER FEDERAL HEALTH CARE PROGRAMS. 

10 (a) IN GENERAL.—Section 1182(e) of the Social Secu11 rity Act (42 U.S.C. 1320e–1(e)) is amended— 

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

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

14 lower value than extending the life of an individual 

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

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

17 (2) by inserting ‘‘described in the preceding sen18 tence’’ after ‘‘such a similar measure’’; 

19 (3) by striking ‘‘The Secretary shall not’’ and in20 serting ‘‘A Federal agency (including the CMI (as de21 scribed in section 1115A)) or State may not’’; 

22 (4) by striking ‘‘under title XVIII.’’ and insert23 ing the following: ‘‘under any Federal health care 

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

25 such term shall include the health program established 


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1 under chapter 89 of title 5, United States Code).’’; 

2 and 

3 (5) by adding at the end the following new sen4 tence: ‘‘Notwithstanding any other provision of law, 

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

6 not waive the application of the provisions of this 

7 subsection (or the provisions of section 1852(o), sec8 tion 1860D–12(h), section 1902(a)(88), section 

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

10 section 1115A, or any other demonstration or waiver 

11 authority.’’. 

12 (b) CONFORMING AMENDMENTS.— 

13 (1) MEDICAID.— 

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

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

16 amended— 

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

18 ‘‘and’’ at the end; 

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

20 the period and inserting ‘‘; and’’; and 

21 (iii) by inserting after paragraph (87) 

22 the following new paragraph: 

23 ‘‘(88) provide for compliance with the require24 ments of section 1182(e) (relating to prohibiting the 


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1 use of certain measures in coverage determinations, 

2 reimbursement, and incentive programs).’’. 

3 (B) MANAGED CARE ORGANIZATIONS.—Sec4 tion 1932(b) of the Social Security Act (42 

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

6 end the following new paragraph: 

7 ‘‘(9) PROHIBITION ON USE OF QUALITY-AD8 JUSTED LIFE YEARS.—The provisions of section 

9 1182(e) shall apply to the utilization of a dollars-per10 quality adjusted life year or similar measure (as de11 scribed in such section) by a medicaid managed care 

12 organization under this title (or a prepaid inpatient 

13 health plan or prepaid ambulatory health plan, as de14 fined in section 438.2 of title 42, Code of Federal Reg15 ulations (or any successor regulation), under a con16 tract with the State) in the same manner as such pro17 visions apply to the utilization of such a year or 

18 measure by a State under this title.’’. 

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

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

21 end the following new subsection: 

22 ‘‘(e) PROHIBITION ON THE USE OF QUALITY-AD23 JUSTED LIFE YEARS AND SIMILAR MEASURES.—A State 

24 child health plan shall provide for compliance with the re25 quirements of section 1182(e) (relating to prohibiting the 


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1 use of certain measures in coverage determinations, reim2 bursement, and incentive programs).’’. 

3 (3) MEDICARE ADVANTAGE.—Section 1852 of the 

4 Social Security Act (42 U.S.C. 1395w–22) is amend5 ed by adding at the end the following new subsection: 

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

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

8 to the utilization of a dollars-per-quality adjusted life year 

9 or similar measure (as described in such section) by an MA 

10 plan in the same manner as such provisions apply to the 

11 utilization of such a year or measure by the Secretary 

12 under this title.’’. 

13 (4) MEDICARE PART D.—Section 1860D–12 of 

14 the Social Security Act (42 U.S.C. 1395w–112) is 

15 amended by adding at the end the following new sub16 section: 

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

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

19 to the utilization of a dollars-per-quality adjusted life year 

20 or similar measure (as described in such section) by a pre21 scription drug plan in the same manner as such provisions 

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

23 Secretary under this title.’’. 

24 (c) IMPLEMENTATION.—The amendments made by this 

25 section shall apply beginning on January 1, 2025. 


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Union Calendar No. 45 

118TH CONGRESS 

1ST SESSION H. R. 485 

[Report No. 118–65, Part I] 

A BILL 

To amend title XI of the Social Security Act to 

minations under Federal health care programs. similar measures in coverage and payment deterprohibit the use of quality-adjusted life years and 

MAY 17, 2023 

Reported from the Committee on Energy and Commerce 

with an amendment 

MAY 17, 2023 

Committee on Ways and Means discharged; committed to 

Union and ordered to be printed the Committee of the Whole House on the State of the 


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