[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1507 Introduced in House (IH)]
113th CONGRESS
1st Session
H. R. 1507
To amend title XVIII of the Social Security Act to increase diagnosis
of Alzheimer's disease and related dementias, leading to better care
and outcomes for Americans living with Alzheimer's disease and related
dementias.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 11, 2013
Mr. Markey (for himself, Mr. Smith of New Jersey, Mr. Burgess, Mrs.
Capito, Ms. Speier, Mr. Johnson of Georgia, Ms. Tsongas, Ms. Norton,
Mr. Fattah, Ms. Moore, Mrs. Carolyn B. Maloney of New York, Mr. Runyan,
Mr. Schiff, Mr. Roskam, Mr. Garamendi, Mr. Tierney, Mr. Israel, and Ms.
Eddie Bernice Johnson of Texas) 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 subsequently
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 increase diagnosis
of Alzheimer's disease and related dementias, leading to better care
and outcomes for Americans living with Alzheimer's disease and related
dementias.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Health Outcomes, Planning, and
Education for Alzheimer's Act''.
SEC. 2. FINDINGS AND PURPOSE.
(a) Findings.--Congress makes the following findings:
(1) As many as half of the estimated 5.2 million Americans
with Alzheimer's disease have never received a diagnosis.
(2) An early and documented diagnosis and access to care
planning services leads to better outcomes for individuals with
Alzheimer's disease and other dementias and their caregivers.
(3) Combining the existing Medicare benefits of a
diagnostic evaluation and care planning into a single package
of services would help ensure that individuals receive an
appropriate diagnosis as well as critical information about the
disease and available care options, which leads to better
outcomes.
(4) An accurate diagnosis allows for better management of
other known chronic conditions and more efficient utilization
of medical resources, including reducing complications and the
number of costly emergency room visits and hospitalizations.
(5) A formal diagnosis allows individuals and their
caregivers to have access to available medical and non-medical
treatments, build a care team, participate in support services,
and enroll in clinical trials.
(6) Undertaking the diagnostic process potentially allows
cognitive impairment to be reversed, as the cognitive
impairment of nine percent of individuals experiencing
dementia-like symptoms is due to a potentially reversible
cause, such as depression or vitamin deficiency.
(b) Purpose.--The purpose of this Act is to increase diagnosis of
Alzheimer's disease and related dementias, leading to better care and
outcomes for Americans living with Alzheimer's disease and related
dementias.
SEC. 3. MEDICARE COVERAGE OF COMPREHENSIVE ALZHEIMER'S DISEASE
DIAGNOSIS AND SERVICES.
(a) In General.--Section 1861 of the Social Security Act (42 U.S.C.
1395x) is amended--
(1) in subsection (s)(2)--
(A) by striking ``and'' at the end of subparagraph
(EE);
(B) by adding ``and'' at the end of subparagraph
(FF); and
(C) by adding at the end the following new
subparagraph:
``(GG) comprehensive Alzheimer's disease diagnosis and
services (as defined in subsection (iii));''; and
(2) by adding at the end the following new subsection:
``Comprehensive Alzheimer's Disease Diagnosis and Services
``(iii)(1) The term `comprehensive Alzheimer's disease diagnosis
and services' means the services described in paragraph (2) furnished
to an individual--
``(A) who does not already have a diagnosis of Alzheimer's
disease; and
``(B) for whom a physician or a practitioner described in
clause (i), (iv), or (v) of section 1842(b)(18)(C), in a
medical setting such as a physician's office, a hospital, a
skilled nursing facility, a community health center, or another
similar medical setting--
``(i) has detected the individual may have a
cognitive impairment or dementia; and
``(ii) pursuant to such detection, has determined a
diagnostic evaluation for Alzheimer's disease is
needed.
``(2) The services described in this paragraph are the following:
``(A) A diagnostic evaluation, including referral to a
specialist if recommended.
``(B) If the individual is diagnosed with Alzheimer's
disease under the diagnostic evaluation under subparagraph (A),
care planning services (with the individual, with the personal
representative of the individual, or with one or more family
caregivers of the individual with or without the presence of
the individual), including assistance understanding the
diagnosis as well as the medical and non-medical options for
ongoing treatment, services, and supports, and information
about how to obtain such treatments, services, and supports.
Such care planning services for individuals diagnosed with
Alzheimer's disease should take into consideration and address
other co-morbid chronic conditions.
``(C) Medical record documentation, with respect to an
individual, of the diagnostic evaluation under subparagraph
(A), the diagnosis, and any care planning services under
subparagraph (B).
``(3) In this subsection--
``(A) the term `Alzheimer's disease' means Alzheimer's
disease and related dementias; and
``(B) the term `personal representative' means, with
respect to an individual, a person legally authorized to make
health care decisions on such individual's behalf.''.
(b) Payment.--Section 1833(a)(1) of the Social Security Act (42
U.S.C. 1395l(a)(1)) is amended by striking ``and'' before ``(Z)'' and
inserting before the semicolon at the end the following: ``, and (AA)
with respect to comprehensive Alzheimer's disease diagnosis and
services (as defined in section 1861(iii)), the amount paid shall be an
amount equal to 80 percent of the amount determined under a fee
schedule designated by the Secretary''.
(c) Effective Date.--The amendments made by this section shall
apply to services furnished on or after January 1 of the year following
the year which includes the date of the enactment of this Act.
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