1.This Act may be cited as the
Health Outcomes, Planning, and
Education for Alzheimer’s Act
.
2.Medicare coverage of
comprehensive Alzheimer’s disease and other dementia diagnosis and
services
(a)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:
(iii)Comprehensive Alzheimer’s disease and other dementia
diagnosis and services(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)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)The amendments made by this section shall apply to services
furnished on or after January 1, 2011.
3.Federal
Coordinated Health Care Office study and report
(a)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)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.