H.R. 3864

119th CONGRESS 1st Session

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.

IN THE HOUSE OF REPRESENTATIVES · June 10, 2025 · Sponsor: Mrs. Cammack

Table of contents

• H.R. 3864
  • SEC. 1. Short title
  • SEC. 2. Prohibiting the use of quality-adjusted life years and similar measures in coverage and payment determinations under Federal health care programs
  • SEC. 3. Prevention and Public Health Fund
  • SEC. 4. Report

SEC. 1. Short title

• This Act may be cited as the Protecting Health Care for All Patients Act of 2025.

SEC. 2. Prohibiting the use of quality-adjusted life years and similar measures in coverage and payment determinations under Federal health care programs

• (a) In general
  • Section 1182(e) of the Social Security Act () is amended— 42 U.S.C. 1320e–1(e)
    • by inserting after ;
    • by striking The Secretary shall notand inserting A Federal agency (including the CMI (as described in section 1115A)) or State may not;
    • by striking and inserting the following: ; and
    • by adding at the end the following new sentence: . 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), section 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 () is amended— 42 U.S.C. 1396a(a)
        • (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:
          • provide for compliance with the requirements 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 () is amended by adding at the end the following new paragraph: 42 U.S.C. 1396u–2(b)
        • (9) 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 medicaid managed care organization under this title (or a prepaid inpatient health plan or prepaid ambulatory health plan, as defined in section 438.2 of title 42, Code of Federal 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 () is amended by adding at the end the following new subsection: 42 U.S.C. 1397bb
      • (e) Prohibition on the use of quality-Adjusted life years and similar measures
        • A State child health plan shall provide for compliance with the requirements of section 1182(e) (relating to prohibiting the use of certain measures in coverage determinations, reimbursement, and incentive programs).
  • (3) Medicare Advantage
    • Section 1852 of the Social Security Act () is amended by adding at the end the following new subsection: 42 U.S.C. 1395w–22
      • (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 () is amended by adding at the end the following new subsection: 42 U.S.C. 1395w–112
      • (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 measure by the Secretary under this title.
• (c) Implementation
  • The amendments made by this section shall apply beginning on January 1, 2027.

SEC. 3. Prevention and Public Health Fund

• Section 4002(b) of the Patient Protection and Affordable Care Act () is amended by striking paragraphs (7), (8), and (9) and inserting the following: 42 U.S.C. 300u–11
  • for each of fiscal years 2026 and 2027, $1,102,000,000;
  • for each of fiscal years 2028 and 2029, $1,327,000,000;
  • for each of fiscal years 2030 and 2031, $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 General of the United States shall submit to Congress a report on how quality-adjusted life years negatively impacts individuals with intellectual and developmental disabilities and their access to care.