---
kind: "section"
citation: "42 U.S.C. § 1320e–1"
title: "42"
title_heading: "The Public Health and Welfare"
number: "1320e–1"
heading: "Limitations on certain uses of comparative clinical effectiveness research"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/1320e-1"
units:
  - "Chapter 7 — Social Security"
  - "Subchapter XI — General Provisions, Peer Review, and Administrative Simplification"
  - "Part D — Comparative Clinical Effectiveness Research"
---

# §1320e–1. Limitations on certain uses of comparative clinical effectiveness research

- (a) The [Secretary](/usc/42/1301.md?p=a-6) may only use evidence and findings from research conducted under [section 1320e of this title](/usc/42/1320e.md) to make a determination regarding coverage under subchapter XVIII if such use is through an iterative and transparent process which [includes](/usc/42/1301.md?p=b) public comment and considers the effect on subpopulations.
- (b) Nothing in [section 1320e of this title](/usc/42/1320e.md) shall be construed as—
  - (1) superceding or modifying the coverage of items or services under subchapter XVIII that the [Secretary](/usc/42/1301.md?p=a-6) determines are reasonable and necessary under [section 1395y(l)(1)](/usc/42/1395y.md?p=l-1) of this title; or
  - (2) authorizing the [Secretary](/usc/42/1301.md?p=a-6) to deny coverage of items or services under such subchapter solely on the basis of comparative clinical effectiveness research.
- (c)
  - (1) The [Secretary](/usc/42/1301.md?p=a-6) shall not use evidence or findings from comparative clinical effectiveness research conducted under [section 1320e of this title](/usc/42/1320e.md) in determining coverage, reimbursement, or incentive programs under subchapter XVIII in a manner that 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, nondisabled, or not terminally ill.
  - (2) [Paragraph (1)](#c-1) shall not be construed as preventing the [Secretary](/usc/42/1301.md?p=a-6) from using evidence or findings from such comparative clinical effectiveness research in determining coverage, reimbursement, or incentive programs under subchapter XVIII based upon a comparison of the difference in the effectiveness of alternative [treatments](/usc/42/11851.md?p=11) in extending an individual’s life due to the individual’s age, disability, or terminal illness.
- (d)
  - (1) The [Secretary](/usc/42/1301.md?p=a-6) shall not use evidence or findings from comparative clinical effectiveness research conducted under [section 1320e of this title](/usc/42/1320e.md) in determining coverage, reimbursement, or incentive programs under subchapter XVIII in a manner that precludes, or with the intent to discourage, an individual from choosing a health care [treatment](/usc/42/11851.md?p=11) based on how the individual values the tradeoff between extending the length of their life and the risk of disability.
  - (2)
    - (A) [^1] [Paragraph (1)](#d-1) shall not be construed to—
      - (i) limit the application of differential copayments under subchapter XVIII based on factors such as cost or type of service; or
      - (ii) prevent the [Secretary](/usc/42/1301.md?p=a-6) from using evidence or findings from such comparative clinical effectiveness research in determining coverage, reimbursement, or incentive programs under such subchapter based upon a comparison of the difference in the effectiveness of alternative health care [treatments](/usc/42/11851.md?p=11) in extending an individual’s life due to that individual’s age, disability, or terminal illness.
  - (3) Nothing in the provisions of, or amendments made by the Patient Protection and Affordable Care Act, shall be construed to limit comparative clinical effectiveness research or any other research, evaluation, or dissemination of information concerning the likelihood that a health care [treatment](/usc/42/11851.md?p=11) will result in disability.
- (e) The Patient-Centered Outcomes Research Institute established under [section 1320e(b)(1) of this title](/usc/42/1320e.md?p=b-1) shall not develop or employ a dollars-per-quality adjusted life year (or similar measure that discounts the value of a life because of an individual’s disability) as a threshold to establish what type of health care is cost effective or recommended. The [Secretary](/usc/42/1301.md?p=a-6) shall not utilize such an adjusted life year (or such a similar measure) as a threshold to determine coverage, reimbursement, or incentive programs under subchapter XVIII.

## Footnotes

[^1]: So in original. No subpar. (B) has been enacted.

## Source credit

(Aug. 14, 1935, ch. 531, title XI, § 1182, as added Pub. L. 111–148, title VI, § 6301(c), Mar. 23, 2010, 124 Stat. 740.)

## Notes

### Editorial Notes

### References in Text

The Patient Protection and Affordable Care Act, referred to in subsec. (d)(3), is Pub. L. 111–148, Mar. 23, 2010, 124 Stat. 119. For complete classification of this Act to the Code, see Short Title note set out under section 18001 of this title and Tables.