[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5926 Introduced in House (IH)]

111th CONGRESS
  2d Session
                                H. R. 5926

To amend title XVIII of the Social Security Act to provide for Medicare 
   coverage of comprehensive Alzheimer's disease and other dementia 
   diagnosis and services in order to improve care and outcomes for 
  Americans living with Alzheimer's disease by increasing detection, 
                     diagnosis, care, and planning.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 29, 2010

Mr. Markey of Massachusetts (for himself, Mr. Smith of New Jersey, Mr. 
  Klein of Florida, and Mr. Garamendi) 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 provide for Medicare 
   coverage of comprehensive Alzheimer's disease and other dementia 
   diagnosis and services in order to improve care and outcomes for 
  Americans living with Alzheimer's disease by increasing detection, 
                     diagnosis, care, and planning.

    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 ``HOPE for Alzheimer's: Health 
Outcomes, Planning, and Education Act''.

SEC. 2. MEDICARE COVERAGE OF COMPREHENSIVE ALZHEIMER'S DISEASE AND 
              OTHER DEMENTIA DIAGNOSIS AND SERVICES.

    (a) In General.--Section 1861 of the Social Security Act 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 and other dementia 
        diagnosis and services (as defined in subsection (iii));''; and
            (2) by adding at the end the following new subsection:

 ``Comprehensive Alzheimer's Disease and Other Dementia Diagnosis and 
                                Services

    ``(iii)(1) The term `comprehensive Alzheimer's disease and other 
dementia 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 or other dementia; and
            ``(B) for whom there has been a determination by a 
        physician or practitioner (as defined in section 
        1842(b)(18)(C)), in a medical setting such as a physician's 
        office, a skilled nursing facility, a community health center, 
        or another similar setting, that the individual--
                    ``(i) may have a cognitive impairment or dementia; 
                and
                    ``(ii) has a need for a diagnostic evaluation for 
                Alzheimer's disease or another dementia.
    ``(2) The services described in this paragraph are the following:
            ``(A) A diagnostic evaluation, including referral to a 
        specialist if recommended, in accordance with guidelines 
        specified by the Secretary.
            ``(B) If the individual is diagnosed with Alzheimer's 
        disease or another dementia under the evaluation under 
        subparagraph (A), care planning services (with the individual 
        or with one or more family caregivers of the individual 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.
            ``(C) Medical record documentation, with respect to an 
        individual, of the diagnostic evaluation under subparagraph (A) 
        and any care planning services under subparagraph (B).
    ``(3) The Secretary shall establish standards to carry out this 
subsection in consultation with Alzheimer's disease and other dementia 
stakeholders, including patients and their advocates, and medical 
experts in the areas of detection, diagnostics, and care planning.''.
    (b) Payment.--Section 1833(a)(1) of the Social Security Act (42 
U.S.C. 1395l(a)(1)) is amended by striking ``and'' before ``(X)'' and 
inserting before the semicolon at the end the following: ``, and (Y) 
with respect to comprehensive Alzheimer's disease and other dementia 
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 established by the Secretary''.
    (c) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 2011.

SEC. 3. FEDERAL COORDINATED HEALTH CARE OFFICE STUDY AND REPORT.

    (a) Study.--The Federal Coordinated Health Care Office (as 
established under section 2602 of the Patient Protection and Affordable 
Care Act (42 U.S.C. 1315b)) shall conduct a study to identify--
            (1) barriers to the detection of Alzheimer's disease and 
        other dementias for dual eligible individuals (as defined in 
        subsection (f) of such section 2602);
            (2) barriers to the furnishing of comprehensive Alzheimer's 
        disease and other dementia diagnosis and services (as defined 
        in section 1866(iii) of the Social Security Act, as added by 
        section 2) to such individuals; and
            (3) ways to eliminate the barriers described in paragraphs 
        (1) and (2).
    (b) Report.--Not later than 2 years after the date of the enactment 
of this Act, the Federal Coordinated Health Care Office shall submit to 
Congress a report on the study conducted under subsection (a) together 
with recommendations for such legislation and administrative actions as 
the Office determines appropriate.
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