[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5681 Introduced in House (IH)]

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114th CONGRESS
  2d Session
                                H. R. 5681

To require the Center for Medicare and Medicaid Innovation to test the 
efficacy of providing Alzheimer's Disease caregiver support services in 
  delaying or reducing the use of institutionalized care for Medicare 
     beneficiaries with Alzheimer's Disease or a related dementia.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              July 7, 2016

    Ms. Linda T. Sanchez of California (for herself and Mr. Roskam) 
 introduced the following bill; which was referred to the Committee on 
    Ways and Means, and in addition to the Committee on Energy and 
Commerce, 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 require the Center for Medicare and Medicaid Innovation to test the 
efficacy of providing Alzheimer's Disease caregiver support services in 
  delaying or reducing the use of institutionalized care for Medicare 
     beneficiaries with Alzheimer's Disease or a related dementia.

    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 ``Alzheimer's Beneficiary and 
Caregiver Support Act''.

SEC. 2. TESTING OF MEDICARE AND MEDICAID COVERAGE OF ALZHEIMER'S 
              DISEASE CAREGIVER SUPPORT SERVICES.

    Section 1115A of the Social Security Act (42 U.S.C. 1315a) is 
amended--
            (1) in subsection (b)(2)--
                    (A) in subparagraph (A), by adding at the end the 
                following new sentence: ``The models selected under 
                this subparagraph shall include the model described in 
                subparagraph (D), which shall be implemented by not 
                later than the date that is 1 year after the date of 
                enactment of such subparagraph.''; and
                    (B) by adding at the end the following new 
                subparagraph:
                    ``(D) Alzheimer's disease caregiver support 
                services model.--The model described in this 
                subparagraph is a model that meets the requirements of 
                subsection (h) with respect to coverage of, and payment 
                for, Alzheimer's Disease caregiver support services (as 
                defined in such subsection).''; and
            (2) by adding at the end the following new subsection:
    ``(h) Coverage of Alzheimer's Disease Caregiver Support Services.--
            ``(1) In general.--Subject to the succeeding provisions of 
        this subsection, for the 3-year period that begins on January 
        1, 2018, the Secretary shall test the efficacy of coverage of, 
        and payment for, Alzheimer's Disease caregiver support services 
        (as defined in paragraph (2)) under the applicable title, in 
        delaying or reducing the use of institutionalized care for 
        applicable Medicare beneficiaries (as defined in paragraph 
        (3)).
            ``(2) Definition of alzheimer's disease caregiver support 
        services.--In this subsection, the term `Alzheimer's Disease 
        caregiver support services' means the following services 
        furnished by an eligible professional (as defined in paragraph 
        (3)) to a family caregiver (as defined in such paragraph) of an 
        applicable Medicare beneficiary (as defined in such paragraph):
                    ``(A) A defined set of counseling sessions over a 
                fixed period of time (as determined appropriate by the 
                Secretary), including a comprehensive baseline 
                interview, two individual counseling sessions, and four 
                family counseling sessions.
                    ``(B) Following such defined set of counseling 
                sessions, a subsequent period (as determined 
                appropriate by the Secretary) of follow-up assessments, 
                support group participation, and ad hoc counseling or 
                consultations to support the family caregiver as needs 
                arise and the health of the applicable Medicare 
                beneficiary changes.
            ``(3) Additional definitions.--In this subsection:
                    ``(A) Applicable medicare beneficiary.--The term 
                `applicable Medicare beneficiary' means an individual--
                            ``(i) who is entitled to benefits under 
                        part A and enrolled under part B of title XVIII 
                        who is not enrolled in a Medicare Advantage 
                        plan under part C of such title, an eligible 
                        organization under section 1876, or a PACE 
                        program under section 1894; and
                            ``(ii) who has been diagnosed with 
                        Alzheimer's Disease or a related dementia.
                    ``(B) Eligible professional.--The term `eligible 
                professional' means an individual who--
                            ``(i) is a clinical social worker (as 
                        defined in section 1861(hh)(1)) or a nurse 
                        practitioner (as defined in section 
                        1861(aa)(5)(A)); and
                            ``(ii) has undergone extensive online 
                        training in the best practices for caregiver 
                        intervention for patients who have been 
                        diagnosed with Alzheimer's Disease or a related 
                        dementia.
                    ``(C) Family caregiver.--The term `family 
                caregiver' means, with respect to an applicable 
                Medicare beneficiary, a spouse, adult child, or other 
                family member of the applicable Medicare beneficiary 
                who is part of the care team of the applicable Medicare 
                beneficiary and receives no monetary compensation for 
                their service as part of the team.
            ``(4) Payment.--The Secretary shall establish payment 
        amounts under this subsection for Alzheimer's Disease caregiver 
        support services.
            ``(5) Number of family caregivers furnished alzheimer's 
        disease caregiver support services.--The Secretary shall select 
        a sufficient number of eligible professionals to participate in 
        the model under this subsection to ensure that the primary 
        family caregiver and at least one other, informal family 
        caregiver of applicable Medicare beneficiaries receive 
        Alzheimer's Disease caregiver support services under this 
        subsection.''.
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