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