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 quality- 
adjusted life years and similar measures in coverage and payment deter-
minations 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 de-
termined 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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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 Secu-
rity 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 sen-
tence’’ after ‘‘such a similar measure’’; 
(3) by striking ‘‘The Secretary shall not’’ and in-
serting ‘‘A Federal agency (including the CMI (as de-
scribed 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 established 
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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 
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use of certain measures in coverage determinations, 
reimbursement, and incentive programs).’’. 
(B) MANAGED CARE ORGANIZATIONS.—Sec-
tion 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 de-
scribed in such section) by a medicaid managed care 
organization under this title (or a prepaid inpatient 
health plan or prepaid ambulatory health plan, as de-
fined in section 438.2 of title 42, Code of Federal Reg-
ulations (or any successor regulation), under a con-
tract with the State) in the same manner as such pro-
visions 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 
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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 amend-
ed 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 sub-
section: 
‘‘(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 pre-
scription drug plan in the same manner as such provisions 
apply to the utilization of such a year or measure by the 
Secretary under this title.’’. 
(c) IMPLEMENTATION.—The amendments made by this 
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 
prohibit the use of quality-adjusted life years and 
similar measures in coverage and payment deter-
minations under Federal health care programs. 
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 
the Committee of the Whole House on the State of the 
Union and ordered to be printed 
VerDate Sep 11 2014 
00:44 May 18, 2023
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