,i  #aae? ,,congress  #b;d ,session  ,h4
 ,r4 #gbec  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,decemb] #aa1         
#bjah,mr4 ,smi? ( ,miss\ri introduc$ !  
foll[+ bill2 :i* 0 ref]r$ to !          
,committee on ,ways & ,means1 & 9       
addition to ! ,committee on ,en]gy &    
,comm]ce1 = a p]iod to be subsequ5tly   
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d title ,,xviii ( !     
,social ,security ,act to m9imize co/s &
 burd5s "u ! ,m$ic>e program by provid+ 
= consid]ation ( ! removal ( c]ta9      
measures applicable to inpati5t         
hospitals & po/-acute c>e inpati5t      
provid]s & provid+ = mean+ful measures4 
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,remove ,extrane\s ,measures t        
,ob/ruct ,value & ,effici5cy ,act or !  
,,remove ,act4  #b4 ,removal ( c]ta9    
quality measures applicable to inpati5t 
hospitals & po/-acute c>e provid]s      
inpati5t provid]s2 provid+ = mean+ful   

measures  7a7 ,removal = inpati5t       
hospitals  7#a7 ,9 g5]al ,section       
#ahhf7;b77#c77;,b77viii7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acieww7b77#c77;,b77viii77 is am5d$ by  
add+ at ! end ! foll[+ new subclause3   
7,,xii7 ,= purposes ( ?is clause1 9     
consid]+ ! removal ( a quality measure1 
! ,secret>y %all base su* consid]ation  
on factors su* z ! foll[+3  7aa7        
,measure p]=mance is s high & unv>y+ t  
mean+ful di/9ctions 9 improvem5ts 9     
p]=mance c no long] be made4  7bb7      
,p]=mance or improvem5t on su* measure  
does n result 9 bett] pati5t outcomes4  
7cc7 ,su* measure does n align ) cl9ical
 guidel9es or practice4  7dd7 ,ano!r    
measure is available t1 ) respect to a  
p>ticul> topic1 is m broadly applicable 
7across sett+s1 populations1 or         
conditions7 ?an ! measure t is be+      
consid]$ = removal = ! p>ticul> topic4  
7ee7 ,ano!r measure is available t1 )   
respect to a p>ticul> topic1 is m       
proximal 9 "t to desir$ pati5t outcomes 

?an ! measure t is be+ consid]$ =       
removal = ! p>ticul> topic4  7ff7 ,ano!r
 measure is available t1 ) respect to a 
p>ticul> topic1 is m /rongly associat$ )
 desir$ pati5t outcomes ?an ! measure t 
is be+ consid]$ = removal = ! p>ticul>  
topic4  7gg7 ,collection or public      
report+ ( ! measure leads to negative   
un9t5d$ consequ5ces4  7hh7 ,! co/s      
7includ+ co/s associat$ ) adm9i/rative  
burd5 to provid]s ( s]vices & suppli]s7 
associat$ ) ! measure outweigh ! b5efit 
( ! cont9u$ use ( ! measure4  7ii7 ,su* 
o!r factors det]m9$ appropriate by !    
,secret>y4  4  7#b7 ,value-bas$ pur*as+ 
program ,section #ahhf7o77#b77;,d7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acieww7o77#b77;,d77 is am5d$--  7,a7 9 
! head+1 by ins]t+ & removal ( aft]     
,replac+2  7,b7 by /rik+ ,subclause     
7,,vi7 & ins]t+ ,subclauses 7,,vi7 &    
7,,xii72 &  7,c7 by /rik+ su* subclause 
applies & ins]t+ su* subclauses apply4  
7b7 ,removal = po/-,acute c>e provid]s  
,section #ahii;,b7h7 ( ! ,social        

,security ,act 7#db ,u4,s4,c4           
#acielll7h77 is am5d$ by add+ at ! end !
 foll[+ new p>agraph3  7#c7 ,measure    
removal factors  7,a7 ,9 g5]al ,9 c>ry+ 
out p>agraph 7#a7 & ! provisions        
specifi$ 9 subp>agraph 7,b71 = purposes 
( evaluat+ quality measures describ$ 9  
su* p>agraph or su* subp>agraph1        
respectively1 ! ,secret>y %all consid]  
removal ( su* a measure bas$ on factors 
su* z ^? describ$ 9 section             
#ahhf7;b77#c77;,b77viii77,,xii74  7,b7  
,report+ provisions & measures describ$ 
,= purposes ( subp>agraph 7,a71 !       
provisions & measures describ$ 9 ?is    
subp>agraph are ! foll[+3  7i7 ,9 ! case
 ( inpati5t rehabilitation facilities1  
section #ahhf7;j77#g7 & ! measures      
describ$ 9 su* section4  7ii7 ,9 ! case 
( long-t]m c>e hospitals1 section       
#ahhf7m77#e7 & ! measures describ$ 9 su*
 section4  7iii7 ,9 ! case ( skill$     
nurs+ facilities1 section #ahhh7;e77#f7 
& ! measures describ$ 9 su* section4    
7iv7 ,9 ! case ( home heal? ag5cies1    

section #ahie7;b77#c77;,b77v7 & !       
measures describ$ 9 su* section4  4  7c7
 ,provid+ = mean+ful measures ,section  
#ahij;,a7a7 ( ! ,social ,security ,act  
7#db ,u4,s4,c4 #acie;aaa-#a7;a77 is     
am5d$ by add+ at ! end ! foll[+ new     
p>agraph3  7#g7 ,mean+ful measures ,9   
select+ & updat+ quality measures = use 
"u ?is title1 ! ,secret>y %all1 z       
practicable1 consid] ! ext5t to :i* su* 
measures satisfy ! foll[+ factors3  7,a7
 ,! measures are pati5t-c5t]$ & mean+ful
 to pati5ts1 cl9icians1 & provid]s4     
7,b7 ,! measures address high-impact    
measure areas t safegu>d public heal?4  
7,c7 ,! measures are outcome-bas$ :]e   
possible4  7,d7 ,! measures m9imize !   
level ( burd5 = provid]s4  7,e7 ,!      
measures create significant opportunity 
= improvem5t2  7,f7 ,! measures align   
across programs & ) o!r payors4  7,g7 ,!
 measures satisfy any o!r factor        
specifi$ by ! ,secret>y4  4