H.R. 3864 — Protecting Health Care for All Patients Act of 2025

This section revises the prohibition in section 1182(e) of the Social Security Act on using a dollars-per-quality adjusted life year (QALY, i.e., a metric assessing treatment value by weighting life years gained by health-related quality of life) or similar measure that discriminates because of an individual's disability—or now also treats extending the life of an elderly, disabled, or terminally ill individual as lower value than for a younger, non-disabled, or non-terminally ill individual—in coverage and payment determinations. It expands the prohibition from the Secretary under Medicare (title XVIII) to any federal agency (including the Center for Medicare and Medicaid Innovation (CMMI)), state, Medicare Advantage (MA) plan, Medicare Part D plan, Medicaid managed care organization (MCO), or Children's Health Insurance Program (CHIP) entity under any federal health care program (broadly defined in section 1128B(f) to include the Federal Employees Health Benefits (FEHB) program); bars waivers of this prohibition (or related provisions) under section 1115, 1115A, or other authorities; and makes conforming amendments to Medicaid (section 1902(a)(88)), Medicaid MCOs (section 1932(b)(9)), CHIP (new section 2102(e)), MA plans (new section 1852(o)), and Part D plans (new section 1860D–12(h)). The amendments apply beginning January 1, 2027.

This section revises the statutory appropriations schedule for the Prevention and Public Health Fund to $1,102 million for each of FY2026 and FY2027, $1,327 million for each of FY2028 and FY2029, and $1,526 million for each of FY2030 and FY2031. (The fund supports HHS activities in health promotion, preventive health services, education in health care use, and related research, training, and employer wellness programs.)

This section directs the Comptroller General of the United States to submit to Congress, not later than one year after the date of enactment of this Act and annually thereafter, a report on how quality-adjusted life years (QALYs) negatively affect individuals with intellectual and developmental disabilities and their access to care.