‘‘(2) STATE CONTRIBUTION AMOUNT.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (C), the amount determined under this 
paragraph for a State for a month in a year is 
equal to the product described in subparagraph 
(A) of section 1935(c)(1) for the State for the 
month, except that the reference in such sub-
paragraph to the total number of full-benefit 
dual eligible individuals shall be deemed a ref-
erence to the total number of applicable dual el-
igible BCP enrollees. 
‘‘(B) FORM AND MANNER OF PAYMENT.— 
The provisions of subparagraphs (B) through 
(D) of section 1935(c)(1) shall apply to pay-
ment by a State to the Secretary under this 
paragraph in the same manner as such sub-
paragraphs apply to payment under section 
1935(c)(1)(A). 
‘‘(C) APPLICATION
OF
DIFFERENT
FAC-
TORS.—In applying subparagraph (A), the fol-
lowing shall be substituted under paragraphs 
(2) and (3) of section 1935(c): 
‘‘(i) The base year State Medicaid per 
capita expenditures for covered part D 
drugs described in subparagraph (A)(i)(I) 
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of such paragraph (2) shall be deemed to 
be the per capita expenditures for health 
care items and services that would apply 
(including any medicare cost-sharing), with 
respect to an applicable dual eligible BCP 
enrollee, if such an individual received ben-
efits only under title XVIII (and not the 
State plan under this title). 
‘‘(ii) Any reference to expenditures for 
covered part D drugs or for prescription 
drug benefits shall be deemed a reference 
to the expenditures for health care items 
and services described in clause (i). 
‘‘(iii) Any reference to 2003 or 2004 
shall be deemed a reference to 2019 or 
2020, respectively. 
‘‘(iv) Any reference to a full-benefit 
dual eligible individual shall be deemed a 
reference to an applicable dual eligible 
BCP enrollee. 
‘‘(v) The applicable growth factor 
under section 1935(c)(4) for a year, with 
respect to a State, shall be the average an-
nual percentage change (to that year from 
the previous year) of the expenditures of 
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the State under the State plan under title 
XIX. 
‘‘(vi) The factor described in section 
1935(c)(5) is deemed to be 90 percent. 
‘‘(3) APPLICABLE
DUAL
ELIGIBLE
BCP
EN-
ROLLEE.—For purposes of this section, the term 
‘applicable dual eligible BCP enrollee’ means, with 
respect to a State, an individual described in sub-
paragraph (A)(ii) of section 1935(c)(6) (taking into 
account the application of subparagraph (B) of such 
section) for such State who is enrolled in a qualified 
BCP under section 1899B. Such term includes, in 
the case of medical assistance for medicare cost- 
sharing under a State plan under this title, an indi-
vidual who is a qualified medicare beneficiary (as de-
fined in section 1905(p)(1)), a qualified disabled and 
working individual (described in section 1905(s)), an 
individual described in section 1902(a)(10)(E)(iii), 
or otherwise entitled to such medicare cost-sharing 
and who is enrolled in such a qualified BCP. 
‘‘(b) COORDINATION OF BENEFITS.— 
‘‘(1) MEDICARE AS PRIMARY PAYOR.—In the 
case of an applicable dual eligible BCP enrollee, not-
withstanding any other provision of this title, med-
ical assistance is not available under this title for 
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health care items or services (or for any cost-sharing 
respecting such health care items and services), and 
the rules under this title relating to the provision of 
medical assistance for such health care items and 
services shall not apply. The provision of benefits 
with respect to such health care items and services 
shall not be considered as the provision of care or 
services under the plan under this title. No payment 
may be made under section 1903(a) for health care 
items and services for which medical assistance is 
not available pursuant to this paragraph. 
‘‘(2) COVERAGE
OF
LONG-TERM
CARE
SERV-
ICES.—In the case of medical assistance under this 
title with respect to coverage of long-term care serv-
ices furnished to an applicable dual eligible BCP en-
rollee, the State may elect to provide such medical 
assistance in the manner otherwise provided in the 
case of individuals who are not full-benefit dual eligi-
ble individuals or through an arrangement with such 
qualified BCP. In no case shall a qualified BCP be 
required to provide to enrollees coverage of long- 
term care services.’’. 
(c) STATE MARKETING MATERIALS FOR DUALLY EL-
IGIBLE INDIVIDUALS.— 
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(1) 
STATE
PLAN
REQUIREMENT.—Section 
1902(a) of the Social Security Act (42 U.S.C. 
1396a(a)) is amended— 
(A) in paragraph (80), by striking ‘‘and’’ 
at the end; 
(B) in paragraph (81), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (81) the 
following: 
‘‘(82) provide that any marketing materials dis-
tributed by the State that are directed at dual eligi-
ble individuals (as defined in section 1915(h)(2)(B)) 
include information on qualified BCPs offered under 
section 1899B.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by this section shall apply to calendar quarters be-
ginning on or after January 1, 2019, without regard 
to whether or not final regulations to carry out such 
amendments have been promulgated by such date. 
(d) PROHIBITION ON COVERAGE OF COST-SHARING 
FOR CERTAIN ITEMS AND SERVICES FURNISHED TO AN 
ENROLLEE OUTSIDE
OF
A QUALIFIED BCP UNDER 
MEDIGAP POLICIES.—Section 1882 of the Social Security 
Act (42 U.S.C. 1395ss) is amended by adding at the end 
the following new subsection: 
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‘‘(aa) PROHIBITION ON COVERAGE OF COST-SHAR-
ING FOR CERTAIN ITEMS AND SERVICES FURNISHED TO 
AN ENROLLEE OUTSIDE OF A QUALIFIED BCP AND DE-
VELOPMENT OF NEW STANDARDS FOR MEDICARE SUP-
PLEMENTAL POLICIES.— 
‘‘(1) DEVELOPMENT.—The Secretary shall re-
quest the National Association of Insurance Com-
missioners to review and revise the standards for 
benefit packages under subsection (p)(1), taking into 
account the changes in benefits resulting from the 
enactment of the Better Care, Lower Cost Act and 
to otherwise update standards to include the require-
ments for cost-sharing described in paragraph (2). 
Such revisions shall be made consistent with the 
rules applicable under subsection (p)(1)(E) with the 
reference to the ‘1991 NAIC Model Regulation’ 
deemed a reference to the NAIC Model Regulation 
as published in the Federal Register on December 4, 
1998, and as subsequently updated by the National 
Association of Insurance Commissioners to reflect 
previous changes in law and the reference to ‘date 
of enactment of this subsection’ deemed a reference 
to the date of enactment of the Better Care, Lower 
Cost Act. To the extent practicable, such revision 
shall provide for the implementation of revised 
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standards for benefit packages as of January 1, 
2019. 
‘‘(2) 
COST-SHARING
REQUIREMENTS.—The 
cost-sharing requirements described in this para-
graph are that, notwithstanding any other provision 
of law, no medicare supplemental policy may provide 
for coverage of cost-sharing with respect to items 
and services (other than emergent services, as de-
fined by the Secretary) furnished to an individual 
enrolled in a qualified BCP under section 1899B by 
a provider of services or supplier that is not a quali-
fied BCP professional (as defined in section 
1899B(k)). 
‘‘(3) RENEWABILITY.—The renewability re-
quirement under subsection (q)(1) shall be satisfied 
with the renewal of the revised package under para-
graph (1) that most closely matches the policy in 
which the individual was enrolled prior to such revi-
sion.’’. 
SEC. 4. CHRONIC SPECIAL NEEDS PLANS. 
Section 1859 of the Social Security Act (42 U.S.C. 
1395w–28) is amended— 
(1) in subsection (f)(4)— 
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(A) by striking ‘‘In the case of’’ and in-
serting ‘‘Subject to subsection (h), in the case 
of’’; and 
(B) by adding at the end the following 
flush text: 
‘‘Notwithstanding any other provision of this section, 
on or after January 1, 2019, the Secretary shall es-
tablish procedures for the transition of those individ-
uals to a Medicare Advantage plan qualified BCP in 
accordance with subsection (h).’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(h) MEDICARE
ADVANTAGE
PLAN
QUALIFIED 
BCPS.— 
‘‘(1) IN GENERAL.—A Medicare Advantage plan 
that is certified as a qualified BCP (referred to in 
this subsection as a ‘Medicare Advantage plan quali-
fied BCP’)— 
‘‘(A) is deemed to be a specialized MA 
plan for special needs individuals described in 
subsection (b)(6)(B)(iii); and 
‘‘(B) may enroll such special needs individ-
uals. 
‘‘(2) SPECIALIZED
BENEFIT
PACKAGES.—A 
Medicare Advantage plan qualified BCP shall have 
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the flexibility to offer specialized benefit packages to 
enrollees described in subsection (b)(6)(B)(iii), con-
sistent with the value-based insurance requirements 
under section 1899B(f). 
‘‘(3) APPLICATION OF BCP REQUIREMENTS.—A 
Medicare Advantage plan qualified BCP shall be 
subject to all requirements applicable to a qualified 
BCP under section 1899B, including enrollment pe-
riods under subsection (c) of that section, applicable 
criteria relating to network adequacy, requirements 
with respect to individual patient-centered chronic 
care plans under subsection (d)(2) of that section, 
applicable criteria with respect to care management 
processes, and quality reporting under subsection (h) 
of that section. 
‘‘(4) APPLICATION
OF
PART
C
REQUIRE-
MENTS.—The provisions of this part, including the 
provisions relating to specialized MA plans for spe-
cial needs individuals described in subsection 
(b)(6)(B)(iii), shall apply to a Medicare Advantage 
plan qualified BCP to the extent they are consistent 
with the provisions of section 1899B.’’. 
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SEC. 5. IMPROVEMENTS TO WELCOME TO MEDICARE VISIT 
AND ANNUAL WELLNESS VISITS. 
(a) 
WELCOME
TO
MEDICARE
VISIT.—Section 
1861(ww)(1) of the Social Security Act (42 U.S.C. 
1395x(ww)(1)) is amended by adding at the end the fol-
lowing new sentence: ‘‘In the case of a BCP eligible indi-
vidual (as defined in section 1899B(b)), such term in-
cludes a standardized functional and health risk assess-
ment (as described in section 1899B(d)(1)) furnished by 
a qualified BCP professional (as defined in section 
1899B(k)).’’. 
(b) 
ANNUAL
WELLNESS
VISIT.—Section 
1861(hhh)(1) of the Social Security Act (42 U.S.C. 
1395x(h)(1)) is amended— 
(1) in subparagraph (A), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (B), by striking the period 
at the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(C) in the case of a BCP eligible indi-
vidual (as defined in section 1899B(b)), that in-
cludes a standardized functional and health risk 
assessment 
(as 
described 
in 
section 
1899B(d)(1)) furnished by a qualified BCP 
professional (as defined in section 1899B(k)).’’. 
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(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on or after 
the date that is one year after the date of enactment of 
this Act. 
SEC. 6. CHRONIC CARE INNOVATION CENTERS. 
(a) DESIGNATION.—Not later than October 1, 2018, 
the Secretary, acting through the Agency for Healthcare 
Research and Quality, shall designate and provide core 
funding for not less than three Chronic Care Innovation 
Centers. The Secretary shall develop a process for entities 
seeking to become a Chronic Care Innovation Center, and 
shall ensure sufficient geographic representation among 
those entities selected. The main objectives of such Cen-
ters shall include the following: 
(1) Improving the understanding of how to 
measure, monitor, and understand quality and effi-
ciency for a patient population with substantial dis-
ease burden. 
(2) Rigorously examining alternative and inno-
vative systems and strategies for efficiently improv-
ing quality and outcomes for common, serious, and 
chronic illnesses. 
(3) Developing and applying improved meth-
odologies for informing policymakers regarding het-
erogeneity in the effectiveness and safety of pro-
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posed interventions, and assessing barriers to the 
implementation of high-priority care. 
(4) Studying organization and management 
practices that result in higher quality of care. 
(5) Defining and improving quality of care for 
patients with the chronic diseases prevalent in pri-
mary care settings. 
(6) Understanding the influence of race, eth-
nicity, and cultural factors on access, quality, and 
outcomes (such as clinical, patient-centered, health 
care utilization, and costs). 
(7) Evaluating new technology to enhance ac-
cess to, and quality of care (such as telemedicine). 
(8) Assessing the use of patient self-manage-
ment and behavioral interventions as a means of im-
proving outcomes for Medicare beneficiaries with 
complex chronic conditions. 
(9) Understanding how management of care is 
affected when patients have multiple chronic condi-
tions in which evidence or recommended guidelines 
are lacking, conflict with, or complicate overall care 
management. 
(10) Characterizing coordination of care within 
and across healthcare systems, including the Depart-
ment of Veterans Affairs, the Medicare program 
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under title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.), the Medicaid program under 
title XIX of such Act, and private sector programs 
for veterans with complex chronic conditions. 
(b) REQUIREMENTS.—In order to be designated a 
Chronic Care Innovation Center under this section, each 
eligible entity must meet the following requirements: 
(1) Develop and implement a sustained research 
agenda in the field of chronic care. 
(2) Collaborate with local schools of public 
health and universities to carry out its mission. 
(3) Actively engage in the development of new, 
best practices for the delivery of care to the chron-
ically ill. 
(4) Actively engage in the development and rou-
tine updating of quality measures for the chronically 
ill. 
(5) Have the ability to convene experts prac-
ticed in the needs of a chronically ill patient, includ-
ing pharmacologists, psychiatrists, cardiologists, 
pulmonologists, rheumatologists, nutritionists and 
dieticians, social workers, and physical therapists. 
(6) Partner with the Secretary of Health and 
Human Services and the Secretary of Veterans Af-
fairs (including the Center for Health Services Re-
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search in Primary Care of the Department of Vet-
erans Affairs Health Services Research and Develop-
ment Service), the medical community, medical 
schools, and public health departments through the 
Agency for Healthcare Research and Quality, the 
Health Resources and Services Administration, and 
the Association of American Medical Colleges to rou-
tinely develop new, forward thinking, and evidence- 
based curricula that addresses the tremendous need 
for team-based care and chronic care management. 
Such curricula shall include palliative medicine, 
chronic care management, leadership and team- 
based skills and planning, and leveraging technology 
as a care tool. 
(c) OVERSIGHT AND EVALUATION.— 
(1) IN GENERAL.—The Agency for Healthcare 
Research and Quality shall be responsible for over-
sight and evaluation of all Chronic Care Innovation 
Centers under this section. 
(2) REPORTS.—Not less frequently than every 
3 years, the Agency for Healthcare Research and 
Quality shall submit to the Secretary of Health and 
Human Services and to Congress a report con-
taining the findings of oversight and evaluations 
conducted under paragraph (1). 
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(d) CONTRACT AUTHORITY.—In order to carry out 
this section, the Secretary may contract with existing Cen-
ters of Innovation (COINs) of the Department of Veterans 
Affairs Health Services Research and Development Serv-
ice that meet the requirements described in subsection (c). 
(e) AUTHORIZATION.—There are authorized to be ap-
propriated such sums as are necessary to carry out this 
section. 
SEC. 7. CURRICULA REQUIREMENTS FOR DIRECT AND IN-
DIRECT 
GRADUATE 
MEDICAL 
EDUCATION 
PAYMENTS. 
(a) DIRECT GRADUATE MEDICAL EDUCATION PAY-
MENTS.—Section 1886(h) of the Social Security Act (42 
U.S.C. 1395ww(h)) is amended by adding at the end the 
following new paragraph: 
‘‘(9) NEW CURRICULA REQUIREMENTS.— 
‘‘(A) DEVELOPMENT.—The Secretary shall 
engage with the medical community and med-
ical schools in developing curricula that meets 
the following requirements: 
‘‘(i) The curricula is new, forward 
thinking, and evidence-based. 
‘‘(ii) The curricula addresses the need 
for team-based care and chronic care man-
agement. 
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‘‘(iii) The curricula includes palliative 
medicine, chronic care management, lead-
ership and team-based skills and planning, 
and leveraging technology as a care tool. 
‘‘(B) RURAL AREAS.—The curricula devel-
oped under subparagraph (A) shall include ap-
propriate focus on care practices required for 
rural and underserved areas. 
‘‘(C) LIMITATION.—Notwithstanding the 
preceding provisions of this subsection, for cost 
reporting periods beginning on or after the date 
that is 5 years after the date of enactment of 
the Better Care, Lower Cost Act, if a hospital 
has not begun to implement curricula that 
meets the requirements described in subpara-
graph (A), payments otherwise made to a hos-
pital under this subsection may be reduced by 
a percentage determined appropriate by the 
Secretary. For purposes of the preceding sen-
tence, successful development and implementa-
tion of such curricula shall be determined by 
program accrediting bodies.’’. 
(b) INDIRECT GRADUATE MEDICAL EDUCATION PAY-
MENTS.—Section 1886(d)(5)(B) of the Social Security Act 
(42 U.S.C. 1395ww(d)(5)(B)) is amended— 
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(1) by redesignating clause (x), as added by 
section 5505(b) of the Patient Protection and Af-
fordable Care Act (Public Law 111–148), as clause 
(xi) and moving such clause 6 ems to the left; and 
(2) by adding at the end the following new 
clause: 
‘‘(xii) Notwithstanding the preceding provisions of 
this subparagraph, effective for discharges occurring on 
or after the date that is 5 years after the date of enact-
ment of the Better Care, Lower Cost Act, if a hospital 
has not begun to implement curricula that meets the re-
quirements described in subsection (h)(9)(A), as deter-
mined in accordance with subsection (h)(9)(C), payments 
otherwise made to a hospital under this subparagraph may 
be reduced by a percentage determined appropriate by the 
Secretary.’’. 
Æ 
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