[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 1692 Introduced in Senate (IS)]
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117th CONGRESS
1st Session
S. 1692
To provide better care and outcomes for Americans living with
Alzheimer's disease and related dementias and their caregivers, while
accelerating progress toward prevention strategies, disease modifying
treatments, and, ultimately, a cure.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 19, 2021
Mrs. Capito (for herself, Ms. Stabenow, Mr. Wicker, and Mr. Menendez)
introduced the following bill; which was read twice and referred to the
Committee on Finance
_______________________________________________________________________
A BILL
To provide better care and outcomes for Americans living with
Alzheimer's disease and related dementias and their caregivers, while
accelerating progress toward prevention strategies, disease modifying
treatments, and, ultimately, a cure.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS; FINDINGS.
(a) Short Title.--This Act may be cited as the ``Concentrating on
High-Value Alzheimer's Needs to Get to an End (CHANGE) Act of 2021''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents; findings.
Sec. 2. Cognitive impairment detection benefit in the Medicare annual
wellness visit and initial preventive
physical examination.
Sec. 3. Medicare quality payment program.
Sec. 4. Report to congress on implementation.
(c) Findings.--Congress finds the following:
(1) It is estimated that 6,200,000 Americans age 65 and
older are living with Alzheimer's disease in 2021. More than 1
in 9 people age 65 and older has Alzheimer's. By 2050, the
number of Americans age 65 and older with Alzheimer's dementia
is projected to reach 12,700,000.
(2) Alzheimer's disease disproportionately impacts women
and people of color.
(3) Almost two-thirds of Americans with Alzheimer's disease
are women.
(4) According to the Centers for Disease Control and
Prevention, among people ages 65 and older, African Americans
have the highest prevalence of Alzheimer's disease and related
dementias (13.8 percent), followed by Hispanics (12.2 percent),
and non-Hispanic Whites (10.3 percent), American Indian and
Alaska Natives (9.1 percent), and Asian and Pacific Islanders
(8.4 percent). This higher prevalence translates into a higher
death rate--Alzheimer's deaths increased 55 percent among all
Americans between 1999 and 2014, while the number was 107
percent for Latinos and 99 percent for African Americans.
(5) Currently available data shows that about half of
individuals age 65 and older with mild cognitive impairment
(MCI)--roughly 5,000,000 Americans--have MCI due to Alzheimer's
disease. Approximately 15 percent of individuals with MCI
develop dementia after 2 years and 32 percent develop
Alzheimer's dementia within 5 years' follow-up.
(6) Addressing modifiable risk factors such as physical
activity, smoking, education, staying socially and mentally
active, blood pressure, and diet might prevent or delay up to
40 percent of dementia cases.
(7) An early, documented diagnosis, communicated to the
patient and caregiver, enables early access to care planning
services and available medical and nonmedical treatments, and
optimizes patients' ability to build a care team, participate
in support services, and enroll in clinical trials.
(8) Alzheimer's exacts an emotional and physical toll on
caregivers, resulting in higher incidence of heart disease,
cancer, depression, and other health consequences.
(9) More than 11,000,000 Americans provide unpaid care for
people with Alzheimer's or other dementia and provided nearly
$257,000,000,000 in unpaid care to people living with
Alzheimer's and other dementias in 2020.
(10) In 2021, it is estimated that Alzheimer's and related
dementias will have cost Medicare and Medicaid programs
$239,000,000,000. By 2050, it is estimated that these direct
costs will increase to as much as $1,100,000,000,000.
SEC. 2. COGNITIVE IMPAIRMENT DETECTION BENEFIT IN THE MEDICARE ANNUAL
WELLNESS VISIT AND INITIAL PREVENTIVE PHYSICAL
EXAMINATION.
(a) Annual Wellness Visit.--
(1) In general.--Section 1861(hhh)(2) of the Social
Security Act (42 U.S.C. 1395x(hhh)(2)) is amended--
(A) by striking subparagraph (D) and inserting the
following:
``(D) Detection of any cognitive impairment or progression
of cognitive impairment that shall--
``(i) be performed using a cognitive impairment detection
tool identified by the National Institute on Aging as meeting
its criteria for selecting instruments to detect cognitive
impairment in the primary care setting, and other validated
cognitive detection tools as the Secretary determines;
``(ii) include documentation of the tool used for detecting
cognitive impairment and results of the assessment in the
medical record of the patient; and
``(iii) take into consideration the tool used, and results
of, any previously performed cognitive impairment detection
assessment.'';
(B) by moving subparagraphs (G) and (H) two ems to
the left;
(C) by redesignating subparagraph (I) as
subparagraph (J); and
(D) by inserting after subparagraph (H) the
following new subparagraph:
``(I) Referral of patients with detected cognitive
impairment or potential cognitive decline to--
``(i) appropriate Alzheimer's disease and dementia
diagnostic services, including amyloid positron
emission tomography, and other medically accepted
diagnostic tests that the Secretary determines are safe
and effective;
``(ii) specialists and other clinicians with
expertise in diagnosing or treating Alzheimer's disease
and related dementias;
``(iii) available community-based services,
including patient and caregiver counseling and social
support services; and
``(iv) appropriate clinical trials.''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply to annual wellness visits furnished on or after
January 1, 2022.
(b) Initial Preventive Physical Examination.--
(1) In general.--Section 1861(ww)(1) of the Social Security
Act (42 U.S.C. 1395x(ww)(1)) is amended by inserting
``detection of any cognitive impairment or progression of
cognitive impairment as described in subparagraph (D) of
subsection (hhh)(2) and referrals as described in subparagraph
(I) of such subsection,'' after ``upon the agreement with the
individual,''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply to initial preventive physical examinations
furnished on or after January 1, 2022.
SEC. 3. MEDICARE QUALITY PAYMENT PROGRAM.
Not later than January 1, 2022, the Secretary of Health and Human
Services shall implement Medicare policies under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.), including quality
measures and Medicare Advantage plan rating and risk adjustment
mechanisms, that reflect the public health imperative of--
(1) promoting healthy brain lifestyle choices;
(2) identifying and responding to patient risk factors for
Alzheimer's disease and related dementias; and
(3) incentivizing providers for--
(A) adequate and reliable cognitive impairment
detection in the primary care setting, that is
documented in the electronic health record of the
patient and communicated to the patient;
(B) timely Alzheimer's disease diagnosis; and
(C) appropriate care planning services, including
identification of, and communication with patients and
caregivers regarding, the potential for clinical trial
participation.
SEC. 4. REPORT TO CONGRESS ON IMPLEMENTATION.
Not later than 3 years after the date of the enactment of this Act,
the Secretary of Health and Human Services shall submit to Congress a
report on the implementation of the provisions of, and amendments made
by, this Act, including--
(1) the increased use of validated tools for detection of
cognitive impairment and Alzheimer's disease;
(2) utilization of Alzheimer's disease diagnostic and care
planning services; and
(3) outreach efforts in the primary care and patient
communities.
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