[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1386 Introduced in House (IH)]

112th CONGRESS
  1st Session
                                H. R. 1386

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


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 6, 2011

  Mr. Markey (for himself, Mr. Smith of New Jersey, Ms. Bordallo, Mr. 
    Burgess, Mrs. Christensen, Mr. Grijalva, Mr. McDermott, and Mr. 
  Pierluisi) 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 related dementia 
   diagnosis and services in order to improve care and outcomes for 
  Americans living with Alzheimer's disease and related dementias by 
           improving detection, diagnosis, and care 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 ``Health Outcomes, Planning, and 
Education for Alzheimer's Act''.

SEC. 2. MEDICARE COVERAGE OF COMPREHENSIVE ALZHEIMER'S DISEASE 
              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 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 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), the diagnosis, and any care planning services under 
        subparagraph (B).
    ``(3) In this subsection, the term `Alzheimer's disease' means 
Alzheimer's disease and related dementias.''.
    (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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