I 
114TH CONGRESS 
2D SESSION 
H. R. 4878 
To amend title XVIII of the Social Security Act to establish a Medicare 
Better Care Program to provide integrated care for Medicare bene-
ficiaries with chronic conditions, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 23, 2016 
Mr. PAULSEN (for himself and Mr. WELCH) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committee on Ways and Means, for a period to be subse-
quently 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 establish 
a Medicare Better Care Program to provide integrated 
care for Medicare beneficiaries with chronic conditions, 
and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Better Care, Lower Cost Act’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
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Sec. 1. Short title; table of contents. 
Sec. 2. Findings. 
Sec. 3. Medicare Better Care Program. 
Sec. 4. Chronic special needs plans. 
Sec. 5. Improvements to welcome to Medicare visit and annual wellness visits. 
Sec. 6. Chronic care innovation centers. 
Sec. 7. Curricula requirements for direct and indirect graduate medical edu-
cation payments. 
SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) The field of medicine is ever-evolving and 
we need a highly skilled, team-oriented workforce 
that can meet the health care needs of today as well 
as the health care challenges of tomorrow. 
(2) The Medicare program should recognize the 
growing uses and benefits of health technology in de-
livering quality and cost-efficient care by encour-
aging the use of telemedicine and remote patient 
monitoring. 
SEC. 3. MEDICARE BETTER CARE PROGRAM. 
(a) IN GENERAL.—Title XVIII of the Social Security 
Act (42 U.S.C. 1395 et seq.) is amended by adding at 
the end the following new section: 
‘‘MEDICARE BETTER CARE PROGRAM 
‘‘SEC. 1899B. (a) ESTABLISHMENT.— 
‘‘(1) IN GENERAL.—Not later than January 1, 
2019, the Secretary shall establish an integrated 
chronic care delivery program (in this section re-
ferred to as the ‘program’) that promotes account-
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ability and better care management for chronically 
ill patient populations and coordinates items and 
services under parts A, B, and D, while encouraging 
investment in infrastructure and redesigned care 
processes that result in high quality and efficient 
service delivery for the most vulnerable and costly 
populations. The program shall— 
‘‘(A) focus on long-term cost containment 
and better overall health of the Medicare popu-
lation by implementing through qualified BCPs 
(as described in paragraph (2)(A)) strategies 
that prevent, delay, or minimize the progression 
of illness or disability associated with chronic 
conditions; and 
‘‘(B) include the program elements de-
scribed in paragraph (2). 
‘‘(2) PROGRAM ELEMENTS.—The following pro-
gram elements are described in this paragraph: 
‘‘(A) A health plan or group of providers 
of services and suppliers, or a health plan work-
ing with such a group, that the Secretary cer-
tifies in accordance with subsection (e) as meet-
ing criteria developed by the Secretary to recog-
nize the challenges of managing a chronically ill 
population, including patient satisfaction and 
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