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 En-
ergy 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 pro-
viding for consideration of the removal of certain meas-
ures applicable to inpatient hospitals and post-acute care 
inpatient providers and providing for meaningful meas-
ures. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Remove Extraneous 
Measures that Obstruct Value and Efficiency Act’’ or the 
‘‘REMOVE Act’’. 
SEC. 2. REMOVAL OF CERTAIN QUALITY MEASURES APPLI-
CABLE TO INPATIENT HOSPITALS AND POST- 
ACUTE CARE PROVIDERS INPATIENT PRO-
VIDERS; 
PROVIDING 
FOR 
MEANINGFUL 
MEASURES. 
(a) REMOVAL FOR INPATIENT HOSPITALS.— 
(1) IN GENERAL.—Section 1886(b)(3)(B)(viii) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395ww(b)(3)(B)(viii)) is amended by adding at the 
end the following new subclause: 
‘‘(XII) For purposes of this clause, in con-
sidering the removal of a quality measure, the 
Secretary shall base such consideration on fac-
tors such as the following: 
‘‘(aa) Measure performance is so high 
and unvarying that meaningful distinctions 
in improvements in performance can no 
longer be made. 
‘‘(bb) Performance or improvement on 
such measure does not result in better pa-
tient outcomes. 
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‘‘(cc) Such measure does not align 
with clinical guidelines or practice. 
‘‘(dd) Another measure is available 
that, with respect to a particular topic, is 
more broadly applicable (across settings, 
populations, or conditions) than the meas-
ure that is being considered for removal 
for the particular topic. 
‘‘(ee) Another measure is available 
that, with respect to a particular topic, is 
more proximal in time to desired patient 
outcomes than the measure that is being 
considered for removal for the particular 
topic. 
‘‘(ff) Another measure is available 
that, with respect to a particular topic, is 
more strongly associated with desired pa-
tient outcomes than the measure that is 
being considered for removal for the par-
ticular topic. 
‘‘(gg) Collection or public reporting of 
the measure leads to negative unintended 
consequences. 
‘‘(hh) The costs (including costs asso-
ciated with administrative burden to pro-
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viders of services and suppliers) associated 
with the measure outweigh the benefit of 
the continued use of the measure. 
‘‘(ii) Such other factors determined 
appropriate by the Secretary.’’. 
(2) VALUE-BASED
PURCHASING
PROGRAM.— 
Section 1886(o)(2)(D) of the Social Security Act (42 
U.S.C. 1395ww(o)(2)(D)) is amended— 
(A) in the heading, by inserting ‘‘AND RE-
MOVAL OF’’ after ‘‘REPLACING’’; 
(B) by striking ‘‘Subclause (VI)’’ and in-
serting ‘‘Subclauses (VI) and (XII)’’; and 
(C) by striking ‘‘such subclause applies’’ 
and inserting ‘‘such subclauses apply’’. 
(b) REMOVAL FOR POST-ACUTE CARE PROVIDERS.— 
Section 1899B(h) of the Social Security Act (42 U.S.C. 
1395lll(h)) is amended by adding at the end the following 
new paragraph: 
‘‘(3) MEASURE REMOVAL FACTORS.— 
‘‘(A) IN GENERAL.—In carrying out para-
graph (1) and the provisions specified in sub-
paragraph (B), for purposes of evaluating qual-
ity measures described in such paragraph or 
such subparagraph, respectively, the Secretary 
shall consider removal of such a measure based 
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on factors such as those described in section 
1886(b)(3)(B)(viii)(XII). 
‘‘(B) REPORTING PROVISIONS AND MEAS-
URES DESCRIBED.—For purposes of subpara-
graph (A), the provisions and measures de-
scribed in this subparagraph are the following: 
‘‘(i) In the case of inpatient rehabili-
tation facilities, section 1886(j)(7) and the 
measures described in such section. 
‘‘(ii) In the case of long-term care 
hospitals, section 1886(m)(5) and the 
measures described in such section. 
‘‘(iii) In the case of skilled nursing fa-
cilities, section 1888(e)(6) and the meas-
ures described in such section. 
‘‘(iv) In the case of home health agen-
cies, section 1895(b)(3)(B)(v) and the 
measures described in such section.’’. 
(c) PROVIDING FOR MEANINGFUL MEASURES.—Sec-
tion 1890A(a) of the Social Security Act (42 U.S.C. 
1395aaa–1(a)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(7) MEANINGFUL
MEASURES.—In selecting 
and updating quality measures for use under this 
title, the Secretary shall, as practicable, consider the 
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