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 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 diagnosis
and services (as defined in subsection
(iii));
;
and
(2)by adding at the
end the following new subsection:
(iii)Comprehensive Alzheimer’s disease diagnosis and
services(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)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)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.