This regulation specifies the criteria CMS may use to remove a quality measure from the expanded Home Health Value-Based Purchasing (HHVBP) Model, such as measures being topped out, misaligned with clinical guidelines, or having costs that outweigh benefits. It applies exclusively to Home Health Agencies (HHAs) participating in the HHVBP program and does not govern any behavioral health, IDD, ABA, or foster care facility type.
View official source§ 484.358 HHVBP Measure removal factors. CMS may remove a quality measure from the expanded HHVBP Model based on one or more of the following factors: (a) Measure performance among HHAs is so high and unvarying that meaningful distinctions in improvements in performance can no longer be made (that is, topped out). (b) Performance or improvement on a measure does not result in better patient outcomes. (c) A measure does not align with current clinical guidelines or practice. (d) A more broadly applicable measure (across settings, populations, or conditions) for the particular topic is available. (e) A measure that is more proximal in time to desired patient outcomes for the particular topic is available. (f) A measure that is more strongly associated with desired patient outcomes for the particular topic is available. (g) Collection or public reporting of a measure leads to negative unintended consequences other than patient harm. (h) The costs associated with a measure outweigh the benefit of its continued use in the program. (i) It is not feasible to implement the measure specifications. [88 FR 77878, Nov. 13, 2023, as amended at 90 FR 55619, Dec. 2, 2025]