[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1559 Introduced in House (IH)]

114th CONGRESS
  1st Session
                                H. R. 1559

To amend title XVIII of the Social Security Act to provide for coverage 
 under the Medicare program of an initial comprehensive care plan for 
  Medicare beneficiaries newly diagnosed with Alzheimer's disease and 
               related dementias, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 24, 2015

Mr. Smith of New Jersey (for himself, Ms. Maxine Waters of California, 
 Mr. Roskam, Mr. Fattah, Mr. Tonko, Mr. Blumenauer, Mr. Garamendi, Mr. 
Duncan of Tennessee, Mr. Buchanan, Mr. Murphy of Florida, Mr. Hinojosa, 
 Mr. David Scott of Georgia, Mr. Yarmuth, Ms. Frankel of Florida, Mr. 
    Johnson of Georgia, Mr. Capuano, Mr. Higgins, Mr. Loebsack, Ms. 
Pingree, Ms. Wilson of Florida, Ms. Slaughter, Mr. Keating, Mr. Sires, 
   Mr. Joyce, Mr. Sarbanes, Ms. Kuster, Mr. Grijalva, Mr. Walz, Mr. 
Harper, Mr. Deutch, Mr. Rangel, Ms. Clark of Massachusetts, Ms. Norton, 
and Mr. Barletta) 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 coverage 
 under the Medicare program of an initial comprehensive care plan for 
  Medicare beneficiaries newly diagnosed with Alzheimer's disease and 
               related dementias, and for other purposes.

    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 (HOPE) for Alzheimer's Act of 2015''.

SEC. 2. FINDINGS AND PURPOSE.

    (a) Findings.--Congress makes the following findings:
            (1) As many as half of the estimated 5,100,000 American 
        seniors with Alzheimer's disease and other dementias have never 
        received a diagnosis.
            (2) An early and documented diagnosis and access to care 
        planning services leads to better outcomes for individuals with 
        Alzheimer's disease and other dementias and their caregivers.
            (3) Building upon the existing Medicare benefit of a 
        diagnostic evaluation to add comprehensive care planning 
        services would help ensure that beneficiaries and their 
        families receive critical information about the disease and 
        available care options, which leads to better outcomes.
            (4) An accurate, timely, and documented diagnosis allows 
        for better management of other known chronic conditions and 
        more efficient utilization of medical resources, including 
        reducing complications and the number of costly emergency room 
        visits and hospitalizations.
            (5) A formal and documented diagnosis and care planning 
        services allow individuals and their caregivers to have access 
        to available medical and non-medical treatments, build a care 
        team, participate in support services, and enroll in clinical 
        trials.
    (b) Purpose.--The purpose of this Act is to provide better care and 
outcomes for Medicare beneficiaries living with Alzheimer's disease and 
related dementias by building upon existing Medicare coverage of a 
diagnostic evaluation for Alzheimer's disease and related dementias to 
add coverage of initial comprehensive care planning services for 
Medicare beneficiaries who are first diagnosed with Alzheimer's disease 
or related dementias on or after the date of the enactment of this Act 
and whose medical records contain the documented diagnosis of the 
disease.

SEC. 3. MEDICARE COVERAGE OF COMPREHENSIVE ALZHEIMER'S DISEASE CARE 
              PLANNING SERVICES.

    (a) In General.--Section 1861 of the Social Security Act (42 U.S.C. 
1395x) 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 care planning 
        services (as defined in subsection (iii));''; and
            (2) by adding at the end the following new subsection:

       ``Comprehensive Alzheimer's Disease Care Planning Services

    ``(iii)(1)(A) Subject to subparagraph (B), the term `comprehensive 
Alzheimer's disease care planning services' means the services 
described in paragraph (2) furnished by a physician or non-physician 
practitioner to any or all of the following:
            ``(i) An eligible individual.
            ``(ii) The personal representative of such eligible 
        individual, with or without the presence of the eligible 
        individual.
            ``(iii) One or more family caregivers of such eligible 
        individual, with or without the presence of the eligible 
        individual.
    ``(B) The Secretary shall establish guidelines for the furnishing 
of Comprehensive Alzheimer's disease care planning services to 
individuals described in clauses (i), (ii), and (iii) of subparagraph 
(A).
    ``(2)(A) Subject to the succeeding provisions of this paragraph, 
the services described in this paragraph are the development and 
furnishing of an initial comprehensive care plan to an eligible 
individual that provides such information and services as the Secretary 
may specify (in consultation with stakeholders as provided in paragraph 
(5)), which--
            ``(i) includes--
                    ``(I) assistance understanding the diagnosis;
                    ``(II) assistance understanding medical and non-
                medical options for ongoing treatment, services, and 
                supports; and
                    ``(III) information about how to obtain the 
                treatments, services, and supports described in 
                subclause (II); and
            ``(ii) takes into account the eligible individual's other 
        co-morbid chronic conditions.
    ``(B) The services described in this paragraph shall also include 
comprehensive medical record documentation, with respect to the 
eligible individual of the care planning services under subparagraph 
(A), by the physician or non-physician practitioner furnishing the 
services.
    ``(3) Subject to paragraph (5), the Secretary shall periodically 
update requirements under this subsection to reflect advances in 
science and technology.
    ``(4)(A) Comprehensive Alzheimer's disease care planning services 
may only be furnished once with respect to each eligible individual.
    ``(B) Nothing in this subsection shall be construed as prohibiting 
an update of any initial comprehensive care plan furnished under this 
subsection to an eligible individual under physicians' services that 
are covered under other provisions of this title, such as care planning 
under personalized prevention plan services (as defined in subsection 
(hhh)(1)).
    ``(5) The Secretary shall consult with stakeholders, such as 
physicians, non-physician practitioners, and organizations that 
represent individuals (including individuals under this title) with 
Alzheimer's disease, with respect to each of the following:
            ``(A) The scope of, and requirements for, services 
        described in paragraph (2).
            ``(B) The periodic updates of requirements under paragraph 
        (3).
    ``(6) In this subsection:
            ``(A) The term `Alzheimer's disease' means Alzheimer's 
        disease and related dementias.
            ``(B) The term `eligible individual' means an individual 
        who--
                    ``(i) has a documented diagnosis of Alzheimer's 
                disease in the medical record; and
                    ``(ii) was first diagnosed as having Alzheimer's 
                disease on or after the date of the enactment of this 
                subsection.
            ``(C) The term `non-physician practitioner' means a 
        practitioner described in clause (i), (iv), or (v) of section 
        1842(b)(18)(C).
            ``(D) The term `personal representative' means, with 
        respect to an individual, a person legally authorized to make 
        health care decisions on such individual's behalf.
            ``(E) The term `physician' has the meaning given that term 
        in subsection (r)(1).''.
    (b) Payment.--
            (1) In general.--Section 1833(a)(1) of the Social Security 
        Act (42 U.S.C. 1395l(a)(1)) is amended--
                    (A) by striking ``and'' before ``(Z)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (AA) with respect to 
                comprehensive Alzheimer's disease care planning 
                services (as defined in section 1861(iii)(2)), the 
                amount paid shall be an amount equal to 80 percent of 
                the lesser of the actual charge for the services or the 
                amount determined under the payment basis determined 
                under section 1848.''.
            (2) Payment under physician fee schedule.--Section 
        1848(j)(3) of the Social Security Act (42 U.S.C. 1395w-4(j)(3)) 
        is amended by inserting ``(2)(GG),'' after ``(2)(FF) (including 
        administration of the health risk assessment),''.
            (3) Frequency limitation.--Section 1862(a)(1) of the Social 
        Security Act (42 U.S.C. 1395y(a)(1)) is amended--
                    (A) in subparagraph (O), by striking ``and'' at the 
                end;
                    (B) in subparagraph (P), by striking the semicolon 
                at the end and inserting ``, and''; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(Q) in the case of comprehensive Alzheimer's disease care 
        planning services (as defined in section 1861(iii)(1)), which 
        are performed more frequently than is covered under such 
        section;''.
    (c) Provider Outreach and Reporting on Care Planning Services.--
            (1) Outreach.--The Secretary of Health and Human Services 
        (in this subsection referred to as the ``Secretary'') shall 
        conduct outreach to physicians and appropriate non-physician 
        practitioners participating under the Medicare program with 
        respect to the amendments made by subsections (a) and (b). Such 
        outreach shall include a comprehensive, one-time education 
        initiative to inform such physicians and practitioners of the 
        addition of comprehensive Alzheimer's disease care planning 
        services as a covered benefit under the Medicare program, 
        including materials on appropriate diagnostic evaluations and 
        explanations of the requirements for eligibility for such 
        services.
            (2) Reports to congress.--
                    (A) Provider outreach.--Not later than one year 
                after the effective date of the amendments made by 
                subsections (a) and (b) (as described in subsection 
                (d)), the Secretary shall submit to the Committee on 
                Ways and Means and the Committee on Energy and Commerce 
                of the House of Representatives and the Committee on 
                Finance of the Senate a report on the outreach 
                conducted under paragraph (1). Such report shall 
                include a description of the methods used for such 
                outreach.
                    (B) Utilization rates.--Not later than 18 months 
                after the effective date of the amendments made by 
                subsections (a) and (b) (as described in subsection 
                (d)) and annually thereafter for the succeeding five 
                years, the Secretary shall submit to the Committee on 
                Ways and Means and the Committee on Energy and Commerce 
                of the House of Representatives and the Committee on 
                Finance of the Senate a report on the number of 
                Medicare beneficiaries who, during the preceding year, 
                were furnished comprehensive Alzheimer's disease care 
                planning services for which payment was made under 
                title XVIII of the Social Security Act (42 U.S.C. 1395 
                et seq.). Each such report shall include information on 
                any barriers Medicare beneficiaries face to access such 
                services and the Secretary's recommendations to 
                eliminate any such barriers.
                    (C) Copy of each report.--On the same day that a 
                report is submitted under subparagraph (A) or (B) of 
                paragraph (2), the Secretary shall transmit a copy of 
                such report to the Advisory Council on Alzheimer's 
                Research, Care, and Services established under section 
                2(e) of the National Alzheimer's Project Act (42 U.S.C. 
                11225(e); Public Law 111-375).
    (d) Effective Date.--The amendments made by subsections (a) and (b) 
shall apply to services furnished on or after January 1 of the year 
beginning after the date of the enactment of this Act.
                                 <all>