I 

115TH CONGRESS 

2D SESSION H. R. 7253 

To amend title XVIII of the Social Security Act to minimize costs and 

burdens under the Medicare program by providing for consideration 

of the removal of certain measures applicable to inpatient hospitals 

and post-acute care inpatient providers and providing for meaningful 

measures. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 11, 2018 

Mr. SMITH of Missouri introduced the following bill; which was referred to the 

Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to minimize 

costs and burdens under the Medicare program by providing for consideration of the removal of certain measures applicable to inpatient hospitals and post-acute care 

inpatient providers and providing for meaningful measures. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Remove Extraneous 

3 Measures that Obstruct Value and Efficiency Act’’ or the 

4 ‘‘REMOVE Act’’. 

5 SEC. 2. REMOVAL OF CERTAIN QUALITY MEASURES APPLI6 CABLE TO INPATIENT HOSPITALS AND POST7 ACUTE CARE PROVIDERS INPATIENT PRO8 VIDERS; PROVIDING FOR MEANINGFUL 

9 MEASURES. 

10 (a) REMOVAL FOR INPATIENT HOSPITALS.— 

11 (1) IN GENERAL.—Section 1886(b)(3)(B)(viii) 

12 of the Social Security Act (42 U.S.C. 

13 1395ww(b)(3)(B)(viii)) is amended by adding at the 

14 end the following new subclause: 

15 ‘‘(XII) For purposes of this clause, in con16 sidering the removal of a quality measure, the 

17 Secretary shall base such consideration on fac18 tors such as the following: 

19 ‘‘(aa) Measure performance is so high 

20 and unvarying that meaningful distinctions 

21 in improvements in performance can no 

22 longer be made. 

23 ‘‘(bb) Performance or improvement on 

24 such measure does not result in better pa25 tient outcomes. 


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1 ‘‘(cc) Such measure does not align 

2 with clinical guidelines or practice. 

3 ‘‘(dd) Another measure is available 

4 that, with respect to a particular topic, is 

5 more broadly applicable (across settings, 

6 populations, or conditions) than the meas7 ure that is being considered for removal 

8 for the particular topic. 

9 ‘‘(ee) Another measure is available 

10 that, with respect to a particular topic, is 

11 more proximal in time to desired patient 

12 outcomes than the measure that is being 

13 considered for removal for the particular 

14 topic. 

15 ‘‘(ff) Another measure is available 

16 that, with respect to a particular topic, is 

17 more strongly associated with desired pa18 tient outcomes than the measure that is 

19 being considered for removal for the par20 ticular topic. 

21 ‘‘(gg) Collection or public reporting of 

22 the measure leads to negative unintended 

23 consequences. 

24 ‘‘(hh) The costs (including costs asso25 ciated with administrative burden to proVerDate Sep 11 2014 23:06 Dec 13, 2018 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H7253.IH H7253

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1 viders of services and suppliers) associated 

2 with the measure outweigh the benefit of 

3 the continued use of the measure. 

4 ‘‘(ii) Such other factors determined 

5 appropriate by the Secretary.’’. 

6 (2) VALUE-BASED PURCHASING PROGRAM.— 

7 Section 1886(o)(2)(D) of the Social Security Act (42 

8 U.S.C. 1395ww(o)(2)(D)) is amended— 

9 (A) in the heading, by inserting ‘‘AND RE10 MOVAL OF’’ after ‘‘REPLACING’’; 

11 (B) by striking ‘‘Subclause (VI)’’ and in12 serting ‘‘Subclauses (VI) and (XII)’’; and 

13 (C) by striking ‘‘such subclause applies’’ 

14 and inserting ‘‘such subclauses apply’’. 

15 (b) REMOVAL FOR POST-ACUTE CARE PROVIDERS.— 

16 Section 1899B(h) of the Social Security Act (42 U.S.C. 

17 1395lll(h)) is amended by adding at the end the following 

18 new paragraph: 

19 ‘‘(3) MEASURE REMOVAL FACTORS.— 

20 ‘‘(A) IN GENERAL.—In carrying out para21 graph (1) and the provisions specified in sub22 paragraph (B), for purposes of evaluating qual23 ity measures described in such paragraph or 

24 such subparagraph, respectively, the Secretary 

25 shall consider removal of such a measure based 


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1 on factors such as those described in section 

2 1886(b)(3)(B)(viii)(XII). 

3 ‘‘(B) REPORTING PROVISIONS AND MEAS4 URES DESCRIBED.—For purposes of subpara5 graph (A), the provisions and measures de6 scribed in this subparagraph are the following: 

7 ‘‘(i) In the case of inpatient rehabili8 tation facilities, section 1886(j)(7) and the 

9 measures described in such section. 

10 ‘‘(ii) In the case of long-term care 

11 hospitals, section 1886(m)(5) and the 

12 measures described in such section. 

13 ‘‘(iii) In the case of skilled nursing fa14 cilities, section 1888(e)(6) and the meas15 ures described in such section. 

16 ‘‘(iv) In the case of home health agen17 cies, section 1895(b)(3)(B)(v) and the 

18 measures described in such section.’’. 

19 (c) PROVIDING FOR MEANINGFUL MEASURES.—Sec20 tion 1890A(a) of the Social Security Act (42 U.S.C. 

21 1395aaa–1(a)) is amended by adding at the end the fol22 lowing new paragraph: 

23 ‘‘(7) MEANINGFUL MEASURES.—In selecting 

24 and updating quality measures for use under this 

25 title, the Secretary shall, as practicable, consider the 


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1 extent to which such measures satisfy the following 

2 factors: 

3 ‘‘(A) The measures are patient-centered 

4 and meaningful to patients, clinicians, and pro5 viders. 

6 ‘‘(B) The measures address high-impact 

7 measure areas that safeguard public health. 

8 ‘‘(C) The measures are outcome-based 

9 where possible. 

10 ‘‘(D) The measures minimize the level of 

11 burden for providers. 

12 ‘‘(E) The measures create significant op13 portunity for improvement; 

14 ‘‘(F) The measures align across programs 

15 and with other payors. 

16 ‘‘(G) The measures satisfy any other factor 

17 specified by the Secretary.’’. 

Æ 


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