[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 898 Reported in Senate (RS)]






                                                       Calendar No. 330
110th CONGRESS
  1st Session
                                 S. 898

    To amend the Public Health Service Act to fund breakthroughs in 
 Alzheimer's disease research while providing more help to caregivers 
           and increasing public education about prevention.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 15, 2007

  Ms. Mikulski (for herself, Mr. Bond, Mrs. Clinton, Ms. Collins, Mr. 
 Menendez, Mr. Dodd, Mr. Kohl, Mr. Isakson, Mrs. Boxer, Mr. Bayh, Mr. 
 Brown, Mr. Coleman, Mr. Durbin, Mr. Reed, Mr. Carper, Mr. Lugar, Mr. 
    Sanders, Ms. Klobuchar, Mr. Burr, Mrs. Murray, Mr. Salazar, Mr. 
Lautenberg, and Mrs. Lincoln) introduced the following bill; which was 
 read twice and referred to the Committee on Health, Education, Labor, 
                              and Pensions

                             August 3, 2007

  Reported by Mr. Kennedy, with an amendment and an amendment to the 
                                 title
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 A BILL


 
    To amend the Public Health Service Act to fund breakthroughs in 
 Alzheimer's disease research while providing more help to caregivers 
           and increasing public education about prevention.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

<DELETED>SECTION 1. SHORT TITLE.</DELETED>

<DELETED>    This Act may be cited as the ``Alzheimer's Breakthrough 
Act of 2007''.</DELETED>

<DELETED>SEC. 2. FINDINGS.</DELETED>

<DELETED>    Congress makes the following findings:</DELETED>
        <DELETED>    (1) Alzheimer's disease is a disorder that 
        destroys cells in the brain. The disease is the leading cause 
        of dementia, a condition that involves gradual memory loss, 
        decline in the ability to perform routine tasks, 
        disorientation, difficulty in learning, loss of language 
        skills, impairment of judgment, and personality changes. As the 
        disease progresses, people with Alzheimer's disease become 
        unable to care for themselves. The loss of brain cells 
        eventually leads to the failure of other systems in the 
        body.</DELETED>
        <DELETED>    (2) An estimated 4,500,000 Americans have 
        Alzheimer's disease and 1 in 10 individuals have a family 
        member with the disease. By 2050, the number of individuals 
        with the disease could range from 13,000,000 to 16,000,000 
        unless science finds a way to prevent or cure the 
        disease.</DELETED>
        <DELETED>    (3) One in 10 people over the age of 65, and 
        nearly half of those over the age of 85 have Alzheimer's 
        disease. Younger people also get the disease.</DELETED>
        <DELETED>    (4) The Alzheimer's disease process may begin in 
        the brain as many as 20 years before the symptoms of 
        Alzheimer's disease appear. An individual will live an average 
        of 8 years and as many as 20 once the symptoms of Alzheimer's 
        disease appear.</DELETED>
        <DELETED>    (5) The average lifetime cost of care for an 
        individual with Alzheimer's disease is $170,000.</DELETED>
        <DELETED>    (6) In 2005, Medicare alone spent $91,000,000,000 
        for the care of individuals with Alzheimer's disease and this 
        amount is projected to increase to $160,000,000,000 in 
        2010.</DELETED>
        <DELETED>    (7) Ninety-five percent of Medicare beneficiaries 
        with Alzheimer's disease have one or more other chronic 
        conditions that are common in the elderly, coronary heart 
        disease (30 percent), congestive heart failure (28 percent), 
        diabetes (21 percent), and chronic obstructive pulmonary 
        disease (17 percent).</DELETED>
        <DELETED>    (8) Seven in 10 individuals with Alzheimer's 
        disease live at home. While almost 75 percent of home care is 
        provided by family and friends, the average annual cost of paid 
        care for people with Alzheimer's disease at home is $19,000 per 
        year. Almost all families pay this cost out of 
        pocket.</DELETED>
        <DELETED>    (9) Half of all nursing home residents have 
        Alzheimer's disease or a related disorder. The average annual 
        cost of Alzheimer's disease nursing home care is more than 
        $70,000. Medicaid pays half of the total nursing home bill and 
        helps 2 out of 3 residents pay for their care. Medicaid 
        expenditures for nursing home care for people with Alzheimer's 
        disease are estimated to increase from $21,000,000,000 in 2005 
        to $24,000,000,000 in 2010.</DELETED>
        <DELETED>    (10) In fiscal year 2007, the Federal Government 
        will spend an estimated $642,000,000 on Alzheimer's disease 
        research. If the United States achieves its research goals 
        (preventing the onset of Alzheimer's disease in those at risk 
        and treating and delaying progression of the disease in those 
        who have symptoms), annual Medicare savings would be 
        $51,000,000,000 by 2015 and $88,000,000,000 by 2020. Annual 
        Medicaid savings would be $10,000,000,000 in 2015 and 
        $17,000,000,000 by 2020 and the projected number of cases of 
        Alzheimer's disease can be reduced by 40 percent by the middle 
        of the century.</DELETED>
        <DELETED>    (11) An analysis by the Montefiore Medical Center 
        and the Albert Einstein College of Medicine estimated that the 
        annual value of the informal care system is $306,000,000,000. 
        Family caregiving comes at enormous physical, emotional, and 
        financial sacrifice, putting the whole system at 
        risk.</DELETED>
        <DELETED>    (12) One in 8 Alzheimer's disease caregivers 
        becomes ill or injured as a direct result of caregiving. One in 
        3 uses medication for problems related to caregiving. Older 
        caregivers are 3 times more likely to become clinically 
        depressed than others in their age group.</DELETED>
        <DELETED>    (13) Elderly spouses strained by caregiving are 63 
        percent more likely to die during a given 4-year period than 
        other spouses their age.</DELETED>
        <DELETED>    (14) Almost 3 of 4 caregivers are women. One in 3 
        has children or grandchildren under the age of 18 living at 
        home. Caregiving leaves them less time for other family members 
        and they are much more likely to report family conflicts 
        because of their caregiving role.</DELETED>
        <DELETED>    (15) Most Alzheimer's disease caregivers work 
        outside the home before beginning their caregiving careers, but 
        caregiving forces them to miss work, cut back to part-time, 
        take less demanding jobs, choose early retirement, or give up 
        work altogether. As a result, in 2002, Alzheimer's disease cost 
        American business an estimated $36,500,000,000 in lost 
        productivity, as well as an additional $24,600,000,000 in 
        business contributions to the total cost of care.</DELETED>

  <DELETED>TITLE I--INCREASING THE FEDERAL COMMITMENT TO ALZHEIMER'S 
                           RESEARCH</DELETED>

<DELETED>SEC. 101. DOUBLING NIH FUNDING FOR ALZHEIMER'S DISEASE 
              RESEARCH.</DELETED>

<DELETED>    (a) In General.--For the purpose of conducting and 
supporting research on Alzheimer's disease (including related 
activities under subpart 5 of part C of title IV of the Public Health 
Service Act (42 U.S.C. 285e et seq.) there is authorized to be 
appropriated $1,300,000,000 for fiscal year 2008, and such sums as may 
be necessary for each of fiscal years 2009 through 2012.</DELETED>
<DELETED>    (b) Aging Process Regarding Women.--Section 445H(b) of the 
Public Health Service Act (42 U.S.C. 285e-10(b)) is amended by striking 
``2003'' and inserting ``2012''.</DELETED>
<DELETED>    (c) Clinical Research and Training Awards.--Section 
445I(d) of the Public Health Service Act (42 U.S.C. 285e-10a(d)) is 
amended by striking ``2005'' and inserting ``2012''.</DELETED>

<DELETED>SEC. 102. PRIORITY TO ALZHEIMER'S DISEASE RESEARCH.</DELETED>

<DELETED>    Section 443 of the Public Health Service Act (42 U.S.C. 
285e) is amended--</DELETED>
        <DELETED>    (1) by striking ``The general'' and inserting 
        ``(a) in general.--The general''; and</DELETED>
        <DELETED>    (2) by adding at the end the following:</DELETED>
<DELETED>    ``(b) Priorities.--The Director of the Institute shall, in 
expending amounts appropriated under this subpart, give priority to 
conducting and supporting Alzheimer's disease research.''.</DELETED>

<DELETED>SEC. 103. ALZHEIMER'S DISEASE PREVENTION INITIATIVE.</DELETED>

<DELETED>    Section 443 of the Public Health Service Act (42 U.S.C. 
285e), as amended by section 102, is further amended by adding at the 
end the following:</DELETED>
<DELETED>    ``(c) Prevention Trials.--The Director of the Institute 
shall increase the emphasis on the need to conduct Alzheimer's disease 
prevention trials within the National Institutes of Health.</DELETED>
<DELETED>    ``(d) Neuroscience Initiative.--The Director of the 
Institute shall ensure that Alzheimer's disease is maintained as a high 
priority for the existing neuroscience initiative.''.</DELETED>

<DELETED>SEC. 104. ALZHEIMER'S DISEASE CLINICAL RESEARCH.</DELETED>

<DELETED>    (a) Clinical Research.--Subpart 5 of part C of title IV of 
the Public Health Service Act (42 U.S.C. 285e et seq.) is amended by 
adding at the end the following:</DELETED>

<DELETED>``SEC. 445J. ALZHEIMER'S DISEASE CLINICAL RESEARCH.</DELETED>

<DELETED>    ``(a) In General.--The Director of the Institute, pursuant 
to subsections (d) and (e) of section 444, shall conduct and support 
cooperative clinical research regarding Alzheimer's disease. Such 
research shall include--</DELETED>
        <DELETED>    ``(1) investigating therapies, interventions, and 
        agents to detect, treat, slow the progression of, or prevent 
        Alzheimer's disease;</DELETED>
        <DELETED>    ``(2) enhancing the national infrastructure for 
        the conduct of clinical trials;</DELETED>
        <DELETED>    ``(3) developing and testing novel approaches to 
        the design and analysis of such trials;</DELETED>
        <DELETED>    ``(4) facilitating the enrollment of patients for 
        such trials, including patients from diverse 
        populations;</DELETED>
        <DELETED>    ``(5) developing improved diagnostics and means of 
        patient assessment for Alzheimer's disease;</DELETED>
        <DELETED>    ``(6) the conduct of clinical trials on potential 
        therapies, including readily available compounds such as herbal 
        remedies and other alternative treatments;</DELETED>
        <DELETED>    ``(7) research to develop better methods of early 
        diagnosis, including the use of current imaging techniques; 
        and</DELETED>
        <DELETED>    ``(8) other research as determined appropriate by 
        the Director of the Institute, the Alzheimer's Disease Centers 
        and Alzheimer's Disease Research Centers established under 
        section 445.</DELETED>
<DELETED>    ``(b) Early Diagnosis and Detection Research.--</DELETED>
        <DELETED>    ``(1) In general.--The Director of the Institute, 
        in consultation with the directors of other relevant institutes 
        and centers of the National Institutes of Health, shall 
        conduct, or make grants for the conduct of, research related to 
        the early detection, diagnosis, and prevention of Alzheimer's 
        disease and of mild cognitive impairment or other potential 
        precursors to Alzheimer's disease.</DELETED>
        <DELETED>    ``(2) Evaluation.--The research described in 
        paragraph (1) may include the evaluation of diagnostic tests 
        and imaging techniques.</DELETED>
        <DELETED>    ``(3) Study.--Not later than 1 year after the date 
        of enactment of this section, the Director of the Institute, in 
        cooperation with the heads of other relevant Federal agencies, 
        shall conduct a study, and submit to Congress a report, to 
        estimate the number of individuals with early-onset Alzheimer's 
        disease (those diagnosed before the age of 65) and related 
        dementias in the United States, the causes of early-onset 
        dementia, and the unique problems faced by such individuals, 
        including problems accessing government services.</DELETED>
<DELETED>    ``(c) Vascular Disease.--The Director of the Institute, in 
consultation with the directors of other relevant institutes and 
centers of the National Institutes of Health, shall conduct, or make 
grants for the conduct of, research related to the relationship of 
vascular disease and Alzheimer's disease, including clinical trials to 
determine whether drugs developed to prevent cerebrovascular disease 
can prevent the onset or progression of Alzheimer's disease.</DELETED>
<DELETED>    ``(d) Treatments and Prevention.--The Director of the 
Institute shall place special emphasis on expediting the translation of 
research findings under this section into effective treatments and 
prevention strategies for at-risk individuals.</DELETED>
<DELETED>    ``(e) National Alzheimer's Coordinating Center.--The 
Director of the Institute may establish a National Alzheimer's 
Coordinating Center to facilitate collaborative research among the 
Alzheimer's Disease Centers and Alzheimer's Disease Research Centers 
established under section 445.''.</DELETED>
<DELETED>    (b) Alzheimer's Disease Centers.--Section 445(a)(1) of the 
Public Health Service Act (42 U.S.C. 285e-2(a)(1)) is amended by 
inserting ``, and outcome measures and disease management'' after 
``treatment methods''.</DELETED>

<DELETED>SEC. 105. RESEARCH ON ALZHEIMER'S DISEASE 
              CAREGIVING.</DELETED>

<DELETED>    Section 445C of the Public Health Service Act (42 U.S.C. 
285e-5) is amended--</DELETED>
        <DELETED>    (1) by striking ``sec. 445c. (a)'' and inserting 
        the following:</DELETED>

<DELETED>``SEC. 445C. RESEARCH ON ALZHEIMER'S DISEASE SERVICES AND 
              CAREGIVING.</DELETED>

<DELETED>    ``(a) Services Research.--'';</DELETED>
        <DELETED>    (2) by striking subsections (b), (c), and 
        (e);</DELETED>
        <DELETED>    (3) by inserting after subsection (a) the 
        following:</DELETED>
<DELETED>    ``(b) Interventions Research.--The Director shall, in 
collaboration with the directors of the other relevant institutes and 
centers of the National Institutes of Health, conduct, or make grants 
for the conduct of, clinical, social, and behavioral research related 
to interventions designed to help caregivers of patients with 
Alzheimer's disease and related disorders and improve patient 
outcomes.''; and</DELETED>
        <DELETED>    (4) in subsection (d) by striking ``(d) the 
        Director'' and inserting ``(c) model curricula and 
        techniques.--The Director''.</DELETED>

<DELETED>SEC. 106. NATIONAL SUMMIT ON ALZHEIMER'S DISEASE.</DELETED>

<DELETED>    (a) In General.--Not later than 3 years after the date of 
enactment of this Act, and every 3 years thereafter, the Secretary of 
Health and Human Services (referred to in this section as the 
``Secretary'') shall convene a summit of researchers, representatives 
of academic institutions, Federal and State policymakers, public health 
professionals, and representatives of voluntary health agencies to 
provide a detailed overview of current research activities at the 
National Institutes of Health, as well as to discuss and solicit input 
related to potential areas of collaboration between the National 
Institutes of Health and other Federal health agencies, including the 
Centers for Disease Control and Prevention, the Administration on 
Aging, the Agency for Healthcare Research and Quality, and the Health 
Resources and Services Administration, related to research, prevention, 
and treatment of Alzheimer's disease.</DELETED>
<DELETED>    (b) Focus Areas.--The summit convened under subsection (a) 
shall focus on--</DELETED>
        <DELETED>    (1) a broad range of Alzheimer's disease research 
        activities relating to biomedical research, prevention 
        research, and caregiving issues;</DELETED>
        <DELETED>    (2) clinical research for the development and 
        evaluation of new treatments for the disease;</DELETED>
        <DELETED>    (3) translational research on evidence-based and 
        cost-effective best practices in the treatment and prevention 
        of the disease;</DELETED>
        <DELETED>    (4) information and education programs for health 
        care professionals and the public relating to the 
        disease;</DELETED>
        <DELETED>    (5) priorities among the programs and activities 
        of the various Federal agencies regarding such diseases; 
        and</DELETED>
        <DELETED>    (6) challenges and opportunities for scientists, 
        clinicians, patients, and voluntary organizations relating to 
        the disease.</DELETED>
<DELETED>    (c) Report.--Not later than 180 days after the date on 
which the National Summit on Alzheimer's Disease is convened under 
subsection (a), the Director of National Institutes of Health shall 
prepare and submit to the appropriate committees of Congress a report 
that includes a summary of the proceedings of the summit and a 
description of Alzheimer's research, education, and other activities 
that are conducted or supported through the national research 
institutes.</DELETED>
<DELETED>    (d) Public Information.--The Secretary shall make readily 
available to the public information about the research, education, and 
other activities relating to Alzheimer's disease and other related 
dementias, conducted or supported by the National Institutes of 
Health.</DELETED>

     <DELETED>TITLE II--PUBLIC HEALTH PROMOTION AND PREVENTION OF 
                     ALZHEIMER'S DISEASE</DELETED>

<DELETED>SEC. 201. ENHANCING PUBLIC HEALTH ACTIVITIES RELATED TO 
              COGNITIVE HEALTH, ALZHEIMER'S DISEASE, AND OTHER 
              DEMENTIA'S.</DELETED>

<DELETED>    Part P of title III of the Public Health Service Act (42 
U.S.C. 280g et seq.) is amended by adding at the end the 
following:</DELETED>

<DELETED>``SEC. 399R. ALZHEIMER'S DISEASE PUBLIC EDUCATION 
              CAMPAIGN.</DELETED>

<DELETED>    ``(a) In General.--The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention, shall 
directly or through grants, cooperative agreements, or contracts to 
eligible entities, conduct, support, and promote the coordination of 
research, investigations, demonstrations, training, and studies 
relating to the control, prevention, and surveillance of the risk 
factors associated with cognitive health, Alzheimer's disease, and 
other dementia's, and seek early recognition and intervention in the 
course of Alzheimer's disease and other dementias.</DELETED>
<DELETED>    ``(b) Certain Activities.--Activities under subsection (a) 
shall include--</DELETED>
        <DELETED>    ``(1) providing support for the dissemination and 
        implementation of the Roadmap to Maintaining Cognitive Health 
        to effectively mobilize the public health community into 
        action;</DELETED>
        <DELETED>    ``(2) the development of coordinated public 
        education programs, services, and demonstrations which are 
        designed to increase general awareness of cognitive function 
        and promote a brain healthy lifestyle;</DELETED>
        <DELETED>    ``(3) the development of targeted communication 
        strategies and tools to educate health professionals and 
        service providers about the early recognition, diagnosis, care, 
        and management of Alzheimer's disease and dementia, and to 
        provide consumers with information about interventions, 
        products, and services that promote cognitive health and assist 
        consumers in maintaining current understanding about cognitive 
        health based on the best science available; and</DELETED>
        <DELETED>    ``(4) provide support for the collection, 
        publication, and analysis of data on the prevalence and 
        incidence of cognitive health, Alzheimer's disease, and other 
        dementias, and the evaluation of existing population-based 
        surveillance systems (such as the Behavioral Risk Factors 
        Surveillance Survey (BRFFS) and the National Health Interview 
        Survey (NHIS)) to identify limitations that exist in the area 
        of cognitive health, and if necessary, the development of a 
        surveillance system for cognitive decline, including 
        Alzheimer's disease and dementia.</DELETED>
<DELETED>    ``(c) Grants.--The Secretary may award grants under this 
section--</DELETED>
        <DELETED>    ``(1) to State and local health agencies for the 
        purpose of--</DELETED>
                <DELETED>    ``(A) coordinating activities related to 
                cognitive health, Alzheimer's disease, and other 
                dementias with existing State-based health programs and 
                community-based organizations;</DELETED>
                <DELETED>    ``(B) providing Alzheimer's disease 
                education and training opportunities and programs for 
                health professionals; and</DELETED>
                <DELETED>    ``(C) developing, testing, evaluating, and 
                replicating effective Alzheimer's disease intervention 
                programs to maintain or improve cognitive health; 
                and</DELETED>
        <DELETED>    ``(2) to nonprofit private health organizations 
        with expertise in providing care and services to individuals 
        with Alzheimer's disease for the purpose of--</DELETED>
                <DELETED>    ``(A) disseminating information to the 
                public;</DELETED>
                <DELETED>    ``(B) testing model intervention programs 
                to improve cognitive health; and</DELETED>
                <DELETED>    ``(C) coordinating existing services with 
                State-based health programs.</DELETED>
<DELETED>    ``(d) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be appropriated 
$15,000,000 for fiscal year 2008, and such sums as may be necessary for 
each of fiscal years 2009 through 2012.''.</DELETED>

        <DELETED>TITLE III--ASSISTANCE FOR CAREGIVERS</DELETED>

<DELETED>SEC. 301. ALZHEIMER'S DISEASE CALL CENTER.</DELETED>

<DELETED>    Part P of title III of the Public Health Service Act (42 
U.S.C. 280g et seq.), as amended by section 201, is further amended by 
adding at the end the following:</DELETED>

<DELETED>``SEC. 399S. ALZHEIMER'S DISEASE CALL CENTER.</DELETED>

<DELETED>    ``(a) In General.--The Secretary, acting through the 
Administration on Aging, shall award a cooperative grant to a non-
profit or community-based organization to support the establishment and 
operation of an Alzheimer's Call Center that is accessible 24 hours a 
day, 7 days a week, to provide expert advice, care consultation, 
information, and referrals nationwide at the national and local level 
regarding Alzheimer's disease.</DELETED>
<DELETED>    ``(b) Activities.--The Alzheimer's Call Center established 
under subsection (a) shall--</DELETED>
        <DELETED>    ``(1) collaborate with the Administration on Aging 
        in the development, modification, and execution of the Call 
        Center's work plan;</DELETED>
        <DELETED>    ``(2) assist the Administration on Aging in 
        developing and sustaining collaborations between the 
        Alzheimer's Call Center, the Eldercare Locator, the grantees 
        under the Alzheimer's Demonstration Program, and the Aging 
        Network;</DELETED>
        <DELETED>    ``(3) provide a 24-hour a day, 7-days a week toll-
        free Call Center with trained professional staff who are 
        available to provide care consultation and crisis intervention 
        to individuals with Alzheimer's disease and other dementias, 
        their family and informal caregivers, and others as 
        appropriate;</DELETED>
        <DELETED>    ``(4) be accessible by telephone through a single 
        1-800 telephone number, website and e-mail address; 
        and</DELETED>
        <DELETED>    ``(5) evaluate the impact of the Call Center's 
        activities and services.</DELETED>
<DELETED>    ``(c) Multilingual Capacity.--The Call Center established 
under this section shall have a multilingual capacity and shall respond 
to inquiries in at least 140 languages through its own bilingual staff 
and with the use of a language translation service.</DELETED>
<DELETED>    ``(d) Response to Emergency and Ongoing Needs.--The Call 
Center established under this section shall collaborate with community-
based organizations, including non-profit agencies and organizations, 
to ensure local, on-the-ground capacity to respond to emergency and on-
going needs of Alzheimer's patients, their families, and informal 
caregivers.</DELETED>
<DELETED>    ``(e) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be appropriated 
$1,000,000 for fiscal year 2008, and such sums as may be necessary for 
each of fiscal years 2009 through 2012.''.</DELETED>

<DELETED>SEC. 302. INNOVATIVE ALZHEIMER'S CARE STATE MATCHING GRANT 
              PROGRAM.</DELETED>

<DELETED>    (a) Authorization of Appropriations.--Section 398B(e) of 
the Public Health Service Act (42 U.S.C. 280c-5(e)) is amended--
</DELETED>
        <DELETED>    (1) by striking ``and such'' and inserting 
        ``such''; and</DELETED>
        <DELETED>    (2) by inserting before the period the following: 
        ``, $25,000,000 for fiscal year 2008, and such sums as may be 
        necessary for each of fiscal years 2009 through 
        2012''.</DELETED>
<DELETED>    (b) Program Expansion.--Section 398(a) of the Public 
Health Service Act (42 U.S.C. 280c-3(a))</DELETED>
        <DELETED>    (1) in paragraph (2), by inserting after ``other 
        respite care'' the following: ``and care consultation including 
        assessment of needs, assistance with planning and problem 
        solving and providing supportive listening'';</DELETED>
        <DELETED>    (2) in paragraph (3), by striking ``; and'' and 
        inserting the following: ``and individuals in frontier areas 
        (as defined as areas with 6 or fewer people per square mile or 
        areas in which it takes people at least 60 minutes or 60 miles 
        to reach a market or service area);'';</DELETED>
        <DELETED>    (3) in paragraph (4), by striking the period at 
        the end and inserting a semicolon; and</DELETED>
        <DELETED>    (4) by adding at the end the following:</DELETED>
        <DELETED>    ``(5) to encourage grantees under this section to 
        coordinate activities with other State officials administering 
        efforts to promote long-term care options that enable older 
        individuals to receive long-term care in home- and community-
        based settings, in a manner responsive to the needs and 
        preferences of older individuals and their family 
        caregivers;</DELETED>
        <DELETED>    ``(6) to encourage grantees under this section 
        to--</DELETED>
                <DELETED>    ``(A) engage in activities that support 
                early detection and diagnosis of Alzheimer's disease 
                and related dementia;</DELETED>
                <DELETED>    ``(B) provide training to medical 
                personnel including hospital staff, emergency room 
                personnel, home health care workers and physician 
                office staff, rehabilitation services providers, and 
                caregivers about how Alzheimer's can affect behavior 
                and impede communication in medical and community 
                settings;</DELETED>
                <DELETED>    ``(C) develop guidelines to provide the 
                medical community with up-to-date information about the 
                best methods of care for individuals with Alzheimer's 
                disease;</DELETED>
                <DELETED>    ``(D) inform community physicians about 
                available resources to assist them in detecting and 
                managing Alzheimer's; and</DELETED>
                <DELETED>    ``(E) raise awareness among community 
                physicians about the availability of community-based 
                organizations which can assist individuals with 
                Alzheimer's and their caregivers;</DELETED>
        <DELETED>    ``(7) to encourage grantees under this section to 
        engage in activities that use findings from evidence-based 
        research on service models and techniques to support 
        individuals with Alzheimer's disease and their caregivers; 
        and</DELETED>
        <DELETED>    ``(8) to encourage grantees under this section to 
        incorporate best practices for effectively serving individuals 
        with Alzheimer's disease in community-based settings into 
        ongoing State systems change and long-term care 
        activities.''.</DELETED>

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Alzheimer's Breakthrough Act of 
2007''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Alzheimer's disease is a disorder that destroys cells 
        in the brain. The disease is the leading cause of dementia, a 
        condition that involves gradual memory loss, decline in the 
        ability to perform routine tasks, disorientation, difficulty in 
        learning, loss of language skills, impairment of judgment, and 
        personality changes. As the disease progresses, people with 
        Alzheimer's disease become unable to care for themselves. The 
        loss of brain cells eventually leads to the failure of other 
        systems in the body.
            (2) An estimated 4,500,000 Americans have Alzheimer's 
        disease and 1 in 10 individuals have a family member with the 
        disease. By 2050, the number of individuals with the disease 
        could range from 13,000,000 to 16,000,000 unless science finds 
        a way to prevent or cure the disease.
            (3) One in 10 people over the age of 65, and nearly half of 
        those over the age of 85 have Alzheimer's disease. Younger 
        people also get the disease.
            (4) The Alzheimer's disease process may begin in the brain 
        as many as 20 years before the symptoms of Alzheimer's disease 
        appear. An individual will live an average of 8 years and as 
        many as 20 once the symptoms of Alzheimer's disease appear.
            (5) The average lifetime cost of care for an individual 
        with Alzheimer's disease is $170,000.
            (6) In 2005, Medicare alone spent $91,000,000,000 for the 
        care of individuals with Alzheimer's disease and this amount is 
        projected to increase to $160,000,000,000 in 2010.
            (7) Ninety-five percent of Medicare beneficiaries with 
        Alzheimer's disease have one or more other chronic conditions 
        that are common in the elderly, coronary heart disease (30 
        percent), congestive heart failure (28 percent), diabetes (21 
        percent), and chronic obstructive pulmonary disease (17 
        percent).
            (8) Seven in 10 individuals with Alzheimer's disease live 
        at home. While almost 75 percent of home care is provided by 
        family and friends, the average annual cost of paid care for 
        people with Alzheimer's disease at home is $19,000 per year. 
        Almost all families pay this cost out of pocket.
            (9) Half of all nursing home residents have Alzheimer's 
        disease or a related disorder. The average annual cost of 
        Alzheimer's disease nursing home care is more than $70,000. 
        Medicaid pays half of the total nursing home bill and helps 2 
        out of 3 residents pay for their care. Medicaid expenditures 
        for nursing home care for people with Alzheimer's disease are 
        estimated to increase from $21,000,000,000 in 2005 to 
        $24,000,000,000 in 2010.
            (10) In fiscal year 2007, the Federal Government will spend 
        an estimated $642,000,000 on Alzheimer's disease research. If 
        the United States achieves its research goals (preventing the 
        onset of Alzheimer's disease in those at risk and treating and 
        delaying progression of the disease in those who have 
        symptoms), annual Medicare savings would be $51,000,000,000 by 
        2015 and $88,000,000,000 by 2020. Annual Medicaid savings would 
        be $10,000,000,000 in 2015 and $17,000,000,000 by 2020 and the 
        projected number of cases of Alzheimer's disease would be 
        reduced by 40 percent by the middle of the century.
            (11) An analysis by the Montefiore Medical Center and the 
        Albert Einstein College of Medicine estimated that the annual 
        value of the informal care system is $306,000,000,000. Family 
        caregiving comes at enormous physical, emotional, and financial 
        sacrifice, putting the whole system at risk.
            (12) One in 8 Alzheimer's disease caregivers becomes ill or 
        injured as a direct result of caregiving. One in 3 uses 
        medication for problems related to caregiving. Older caregivers 
        are 3 times more likely to become clinically depressed than 
        others in their age group.
            (13) Elderly spouses strained by caregiving are 63 percent 
        more likely to die during a given 4-year period than other 
        spouses their age.
            (14) Almost 3 of 4 caregivers are women. One in 3 has 
        children or grandchildren under the age of 18 living at home. 
        Caregiving leaves them less time for other family members and 
        they are much more likely to report family conflicts because of 
        their caregiving role.
            (15) Most Alzheimer's disease caregivers work outside the 
        home before beginning their caregiving careers, but caregiving 
        forces them to miss work, cut back to part-time, take less 
        demanding jobs, choose early retirement, or give up work 
        altogether. As a result, in 2002, Alzheimer's disease cost 
        American business an estimated $36,500,000,000 in lost 
        productivity, as well as an additional $24,600,000,000 in 
        business contributions to the total cost of care.

   TITLE I--INCREASING THE FEDERAL COMMITMENT TO ALZHEIMER'S RESEARCH

SEC. 101. INCREASE IN NIH FUNDING FOR ALZHEIMER'S DISEASE RESEARCH.

    For the purpose of conducting and supporting research on 
Alzheimer's disease, cognitive health, and related disorders (including 
related activities under subpart 5 of part C of title IV of the Public 
Health Service Act (42 U.S.C. 285e et seq.) there is authorized to be 
appropriated $780,000,000 for fiscal year 2008, $910,000,000 for fiscal 
year 2009, $1,040,000,000 for fiscal year 2010, $1,170,000,000 for 
fiscal year 2011, and $1,300,000,000 for fiscal year 2012.

SEC. 102. PRIORITY TO ALZHEIMER'S DISEASE RESEARCH.

    Section 444(d) of the Public Health Service Act (42 U.S.C. 285e-
1(d)) is amended by adding at the end the following: ``The Director of 
the Institute shall continue to make research related to Alzheimer's 
Disease, cognitive health, and related disorders', a priority within 
the Institute's activities consistent with the peer-review process.''.

SEC. 103. ALZHEIMER'S DISEASE PREVENTION INITIATIVE.

    Section 444 of the Public Health Service Act (42 U.S.C. 285e-1), as 
amended by section 102, is further amended by adding at the end the 
following:
    ``(e) Prevention Trials.--The Director of the Institute, shall 
increase the emphasis on the need to conduct Alzheimer's disease, 
cognitive health, and related disorders prevention trials within the 
National Institutes of Health.
    ``(f) Neuroscience Initiative.--The Director of the Institute, 
shall ensure that Alzheimer's disease, cognitive health, and related 
disorders is maintained as a high priority for the existing 
neuroscience initiative.''.

SEC. 104. ALZHEIMER'S DISEASE CLINICAL RESEARCH.

    (a) Clinical Research.--Subpart 5 of part C of title IV of the 
Public Health Service Act (42 U.S.C. 285e et seq.) is amended by adding 
at the end the following:

``SEC. 445J. ALZHEIMER'S DISEASE CLINICAL RESEARCH.

    ``(a) In General.--The Secretary, acting through the Director of 
the Institute, pursuant to subsection (d) of section 444, shall, 
consistent with the peer-review and priority setting process of the 
Institute, conduct and support cooperative clinical research regarding 
Alzheimer's disease, cognitive health, and related disorders. Such 
research may include--
            ``(1) investigating therapies, interventions, and agents to 
        detect, treat, slow the progression of, or prevent Alzheimer's 
        disease;
            ``(2) enhancing the national infrastructure for the conduct 
        of clinical trials;
            ``(3) developing and testing novel approaches to the design 
        and analysis of such trials;
            ``(4) facilitating the enrollment of patients for such 
        trials, including patients from diverse populations;
            ``(5) developing improved diagnostics and means of patient 
        assessment for Alzheimer's disease;
            ``(6) the conduct of clinical trials on potential 
        therapies, including readily available compounds such as herbal 
        remedies and other alternative treatments;
            ``(7) research to develop better methods of early 
        diagnosis, including the use of current imaging techniques;
            ``(8) enhance research currently being done on minorities 
        and health disparities; and
            ``(9) other research as determined appropriate by the 
        Director of the Institute, the Alzheimer's Disease Centers and 
        Alzheimer's Disease Research Centers established under section 
        445.
    ``(b) Early Diagnosis and Detection Research.--
            ``(1) In general.--The Secretary, acting through the 
        Director of the Institute, in consultation with the directors 
        of other relevant institutes and centers of the National 
        Institutes of Health, shall conduct, or make grants for the 
        conduct of, research related to the early detection, diagnosis, 
        and prevention of Alzheimer's disease and of mild cognitive 
        impairment or other potential precursors to Alzheimer's 
        disease.
            ``(2) Evaluation.--The research described in paragraph (1) 
        may include the evaluation of diagnostic tests and imaging 
        techniques.
            ``(3) Study on the prevalence and causes of early onset 
        dementia.--The Director of the Institute is encouraged to 
        explore the feasibility and scientific opportunities in 
        research regarding the prevalence and causes of early onset 
        dementia (diagnosed before the age of 65).
    ``(c) Vascular Disease.--The Secretary, acting through the Director 
of the Institute, in consultation with the directors of other relevant 
institutes and centers of the National Institutes of Health, are 
strongly encouraged to conduct or make grants for the conduct of 
research related to the relationship of vascular disease and 
Alzheimer's disease and related disorders, including clinical trials to 
determine whether drugs developed to prevent cerebrovascular disease 
can prevent the onset or progression of Alzheimer's disease.
    ``(d) Treatments and Prevention.--The Secretary, acting through the 
Director of the Institute, shall place special emphasis on expediting 
the translation of research findings under this section into effective 
treatments and prevention strategies for at-risk individuals.
    ``(e) National Alzheimer's Coordinating Center.--The Secretary, 
acting through the Director of the Institute, may establish a National 
Alzheimer's Coordinating Center to facilitate collaborative research 
among the Alzheimer's Disease Centers and Alzheimer's Disease Research 
Centers established under section 445.''.
    (b) Alzheimer's Disease Centers.--Section 445(a)(1) of the Public 
Health Service Act (42 U.S.C. 285e-2(a)(1)) is amended by inserting ``, 
and outcome measures and disease management'' after ``treatment 
methods''.

SEC. 105. RESEARCH ON ALZHEIMER'S DISEASE CAREGIVING.

    Section 445C of the Public Health Service Act (42 U.S.C. 285e-5) is 
amended--
            (1) by striking ``sec. 445c. (a)'' and inserting the 
        following:

``SEC. 445C. RESEARCH ON ALZHEIMER'S DISEASE SERVICES AND CAREGIVING.

    ``(a) Services Research.--'';
            (2) by striking subsections (b), (c), and (e);
            (3) by inserting after subsection (a) the following:
    ``(b) Interventions Research.--The Secretary, acting through the 
Director, shall, in collaboration with the directors of the other 
relevant institutes and centers of the National Institutes of Health, 
conduct, or make grants for the conduct of, clinical, social, and 
behavioral research related to interventions designed to help 
caregivers of patients with Alzheimer's disease and related disorders 
and improve patient outcomes.''; and
            (4) in subsection (d) by striking ``(d) the Director'' and 
        inserting ``(c) Model Curricula and Techniques.--The 
        Director''.

SEC. 106. NATIONAL SUMMIT ON ALZHEIMER'S DISEASE AND RELATED DISORDERS.

    (a) In General.--Not later than 3 years after the date of enactment 
of this Act, and every 3 years thereafter, the Secretary of Health and 
Human Services (referred to in this section as the ``Secretary'') shall 
convene a summit of researchers, representatives of academic 
institutions, Federal and State policy makers, public health 
professionals, community health organizations, and representatives of 
voluntary health organizations to provide a detailed overview of 
current research activities at the National Institutes of Health, as 
well as to discuss and solicit input related to potential areas of 
collaboration between the National Institutes of Health and other 
Federal health agencies, including the Centers for Disease Control and 
Prevention, the Administration on Aging, the Agency for Healthcare 
Research and Quality, and the Health Resources and Services 
Administration, related to research, prevention, and treatment of 
Alzheimer's disease.
    (b) Focus Areas.--The summit convened under subsection (a) shall 
focus on--
            (1) a broad range of Alzheimer's disease research 
        activities relating to breakthroughs in biomedical research, 
        prevention research, and caregiving issues;
            (2) clinical research for the development and evaluation of 
        new treatments for Alzheimer's disease;
            (3) translational research on evidence-based and cost-
        effective best practices in the treatment and prevention of 
        Alzheimer's disease;
            (4) international research and activities relating to 
        breakthroughs in prevention, diagnosis, and treatment of 
        Alzheimer's disease;
            (5) advances in complimentary and alternative medicine 
        related to Alzheimer's disease;
            (6) information and education programs for health care 
        professionals and the public relating to Alzheimer's disease;
            (7) priorities among the programs and activities of the 
        various Federal agencies related to Alzheimer's disease; and
            (8) challenges and opportunities for scientists, 
        clinicians, patients, and voluntary organizations relating to 
        Alzheimer's disease.
    (c) Report.--Not later than 180 days after the date on which the 
National Summit on Alzheimer's Disease is convened under subsection 
(a), the Secretary, acting through the Director of National Institutes 
of Health, shall prepare and submit to the appropriate committees of 
Congress a report that includes a summary of the proceedings of the 
summit and a description of Alzheimer's research, education, and other 
activities that are conducted or supported through the national 
research institutes.
    (d) Public Information.--The Secretary shall make readily available 
to the public information about the research, education, and other 
activities relating to Alzheimer's disease and other related dementias, 
conducted or supported by the National Institutes of Health.

   TITLE II--ENHANCED PUBLIC HEALTH ACTIVITIES RELATED TO COGNITIVE 
            HEALTH, ALZHEIMER'S DISEASE AND OTHER DEMENTIAS

SEC. 201. ENHANCED PUBLIC HEALTH ACTIVITIES RELATED TO COGNITIVE 
              HEALTH, ALZHEIMER'S DISEASE, AND OTHER DEMENTIAS.

    Part P of title III of the Public Health Service Act (42 U.S.C. 
280g et seq.) is amended by adding at the end the following:

``SEC. 399R. ALZHEIMER'S DISEASE PUBLIC EDUCATION AWARENESS PROGRAM.

    ``(a) In General.--The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, shall directly or 
through grants, cooperative agreements, or contracts to eligible 
entities, conduct, support, and promote the coordination of research, 
investigations, demonstrations, training, and studies relating to the 
control, prevention, and surveillance of the risk factors associated 
with cognitive health, Alzheimer's disease, and related disorders, and 
seek early recognition and intervention in the course of Alzheimer's 
disease and related disorders.
    ``(b) Certain Activities.--Activities under subsection (a) may 
include--
            ``(1) providing support for the dissemination and 
        implementation of the Roadmap to Maintaining Cognitive Health 
        to effectively mobilize the public health community into 
        action;
            ``(2) the development of coordinated public education 
        programs, services, and demonstrations which are designed to 
        increase general awareness of cognitive function and promote a 
        brain healthy lifestyle;
            ``(3) the development of targeted communication strategies 
        and tools to educate health professionals and service providers 
        about the early recognition, diagnosis, care, and management of 
        Alzheimer's disease and related disorders, and to provide 
        consumers with information about interventions, products, and 
        services that promote cognitive health and assist consumers in 
        maintaining current understanding about cognitive health based 
        on the best science available; and
            ``(4) provide support for the collection, publication, and 
        analysis of data on the prevalence and incidence of cognitive 
        function, Alzheimer's disease and related disorders, and the 
        related public health burden, and the evaluation of existing 
        population-based surveillance systems (such as the Behavioral 
        Risk Factors Surveillance Survey (BRFFS) and the National 
        Health Interview Survey (NHIS)) to identify limitations that 
        exist in the area of cognitive health, and if necessary, the 
        development of a surveillance system for cognitive decline, 
        including Alzheimer's disease and related disorders.
    ``(c) Grants.--The Secretary may award grants under this section--
            ``(1) to State and local health agencies and health 
        organizations for the purpose of--
                    ``(A) coordinating activities related to 
                Alzheimer's disease, cognitive health, and related 
                disorders with existing State-based health programs and 
                community-based organizations;
                    ``(B) providing Alzheimer's disease, cognitive 
                health, and related disorders education and training 
                opportunities and programs for health professionals; 
                and
                    ``(C) developing, testing, evaluating, and 
                replicating effective Alzheimer's disease and related 
                disorders intervention programs to maintain or improve 
                cognitive health; and
            ``(2) to nonprofit private health organizations with 
        expertise in providing care and services to individuals with 
        Alzheimer's disease and related disorders for the purpose of--
                    ``(A) disseminating information to the public;
                    ``(B) testing model intervention programs to 
                improve cognitive health; and
                    ``(C) coordinating existing services with State-
                based health programs.
    ``(d) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated $3,000,000 
for each of fiscal years 2008 through 2012.''.

                  TITLE III--ASSISTANCE FOR CAREGIVERS

SEC. 301. ALZHEIMER'S DISEASE CALL CENTER.

    Part P of title III of the Public Health Service Act (42 U.S.C. 
280g et seq.), as amended by section 201, is further amended by adding 
at the end the following:

``SEC. 399S. ALZHEIMER'S DISEASE CALL CENTER.

    ``(a) In General.--The Secretary, acting through the Administration 
on Aging, shall award a cooperative grant to a non-profit or community-
based organization to support the establishment and operation of an 
Alzheimer's Call Center that is accessible 24 hours a day, 7 days a 
week, to provide expert advice, care consultation, information, and 
referrals nationwide at the national and local level regarding 
Alzheimer's disease and related disorders.
    ``(b) Activities.--The Alzheimer's Call Center established under 
subsection (a) shall--
            ``(1) collaborate with the Administration on Aging in the 
        development, modification, and execution of the Call Center's 
        work plan;
            ``(2) assist the Administration on Aging in developing and 
        sustaining collaborations between the Alzheimer's Call Center, 
        the Eldercare Locator, the grantees under the Alzheimer's 
        Demonstration Program, and the Aging Network;
            ``(3) provide a 24-hour a day, 7-days a week toll-free Call 
        Center with trained professional staff who are available to 
        provide care consultation and crisis intervention to 
        individuals with Alzheimer's disease and other dementias, their 
        family and informal caregivers, and others as appropriate;
            ``(4) be accessible by telephone through a single 1-800 
        telephone number, website and e-mail address; and
            ``(5) evaluate the impact of the Call Center's activities 
        and services.
    ``(c) Multilingual Capacity.--The Call Center established under 
this section shall have a multilingual capacity and shall respond to 
inquiries in at least 140 languages through its own bilingual staff and 
with the use of a language translation service.
    ``(d) Response to Emergency and Ongoing Needs.--The Call Center 
established under this section shall collaborate with community-based 
organizations, including non-profit agencies and organizations, to 
ensure local, on-the-ground capacity to respond to emergency and on-
going needs of Alzheimer's patients, their families, and informal 
caregivers.
    ``(e) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated $1,000,000 
for fiscal year 2008, and such sums as may be necessary for each of 
fiscal years 2009 through 2012.''.

SEC. 302. INNOVATIVE ALZHEIMER'S CARE STATE MATCHING GRANT PROGRAM.

    (a) Authorization of Appropriations.--Section 398B(e) of the Public 
Health Service Act (42 U.S.C. 280c-5(e)) is amended--
            (1) by striking ``and such'' and inserting ``such''; and
            (2) by inserting before the period the following: ``, and 
        $20,000,000 for each of fiscal years 2008 through 2012''.
    (b) Program Expansion.--Section 398(a) of the Public Health Service 
Act (42 U.S.C. 280c-3(a))
            (1) in paragraph (2), by inserting after ``other respite 
        care'' the following: ``and care consultation including 
        assessment of needs, assistance with planning and problem 
        solving and providing supportive listening'';
            (2) in paragraph (3), by striking ``; and'' and inserting 
        the following: ``and individuals in frontier areas (as defined 
        as areas with 6 or fewer people per square mile or areas in 
        which it takes people at least 60 minutes or 60 miles to reach 
        a market or service area);'';
            (3) in paragraph (4), by striking the period at the end and 
        inserting a semicolon; and
            (4) by adding at the end the following:
            ``(5) to encourage grantees under this section to 
        coordinate activities with other State officials administering 
        efforts to promote long-term care options that enable older 
        individuals to receive long-term care in home- and community-
        based settings, in a manner responsive to the needs and 
        preferences of older individuals and their family caregivers;
            ``(6) to encourage grantees under this section to--
                    ``(A) engage in activities that support early 
                detection and diagnosis of Alzheimer's disease and 
                related disorders;
                    ``(B) provide training to medical personnel 
                including hospital staff, emergency room personnel, 
                home health care workers and physician office staff, 
                rehabilitation services providers, and caregivers about 
                how Alzheimer's can affect behavior and impede 
                communication in medical and community settings;
                    ``(C) develop guidelines to provide the medical 
                community with up-to-date information about the best 
                methods of care for individuals with Alzheimer's 
                disease and related disorders;
                    ``(D) inform community physicians about available 
                resources to assist them in detecting and managing 
                Alzheimer's disease and related disorders; and
                    ``(E) raise awareness among community physicians 
                about the availability of community-based organizations 
                which can assist individuals with Alzheimer's disease 
                and related disorders and their caregivers;
            ``(7) to encourage grantees under this section to engage in 
        activities that use findings from evidence-based research on 
        service models and techniques to support individuals with 
        Alzheimer's disease and related disorders and their caregivers;
            ``(8) to encourage grantees under this section to 
        incorporate best practices for effectively serving individuals 
        with Alzheimer's disease and related disorders in community-
        based settings into ongoing State systems change and long-term 
        care activities; and
            ``(9) to encourage grantees to coordinate with Aging and 
        Disability Resource Centers or other single point of entry 
        systems.''.
            Amend the title so as to read: ``A bill to amend the Public 
        Health Service Act to fund breakthroughs in Alzheimer's disease 
        research while providing more help to caregivers and increasing 
        public and provider awareness about steps that may be taken to 
        respond rapidly to breakthroughs in prevention, early 
        detection, and management, about cognitive health, Alzheimer's 
        disease, and other dementias related to aging.''.
                                                       Calendar No. 330

110th CONGRESS

  1st Session

                                 S. 898

_______________________________________________________________________

                                 A BILL

    To amend the Public Health Service Act to fund breakthroughs in 
 Alzheimer's disease research while providing more help to caregivers 
           and increasing public education about prevention.

_______________________________________________________________________

                             August 3, 2007

        Reported with an amendment and an amendment to the title