---
kind: "section"
citation: "42 C.F.R. § 484.358"
title: "42"
number: "484.358"
heading: "HHVBP Measure removal factors."
url: "https://uscodex.org/cfr/42/484.358"
---

# §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.**

## Notes

### Amendments

[88 FR 77878, Nov. 13, 2023, as amended at 90 FR 55619, Dec. 2, 2025]

### Source

Source: 86 FR 62422, Nov. 9, 2021, unless otherwise noted.

### Source

Source: 80 FR 68718, Nov. 5, 2015, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302 and 1395hh.

### Source

Source: 54 FR 33367, Aug. 14, 1989, unless otherwise noted.

### Amendments

[88 FR 77878, Nov. 13, 2023, as amended at 90 FR 55619, Dec. 2, 2025]