[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2283 Introduced in House (IH)]
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116th CONGRESS
1st Session
H. R. 2283
To provide better care and outcomes for Americans living with
Alzheimer's disease and related dementias and their caregivers while
accelerating progress toward prevention strategies, disease modifying
treatments, and, ultimately, a cure.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 10, 2019
Ms. Sanchez (for herself, Mr. LaHood, Ms. Matsui, and Mrs. Rodgers of
Washington) 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 provide better care and outcomes for Americans living with
Alzheimer's disease and related dementias and their caregivers while
accelerating progress toward prevention strategies, disease modifying
treatments, and, ultimately, a cure.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS; FINDINGS.
(a) Short Title.--This Act may be cited as the ``Concentrating on
High-value Alzheimer's Needs to Get to an End Act of 2019'' or the
``CHANGE Act of 2019''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents; findings.
Sec. 2. Cognitive impairment detection benefit in the Medicare annual
wellness visit and initial preventive
physical examination.
Sec. 3. Medicare quality payment program.
Sec. 4. Report to Congress on implementation of this Act.
Sec. 5. Study and report on regulatory and legislative changes or
refinements that would accelerate
Alzheimer's disease research progress.
(c) Findings.--Congress finds as follows:
(1) It is estimated that 5.8 million Americans are living
with Alzheimer's disease in 2019. This includes an estimated
5.6 million people age 65 and older and approximately 200,000
individuals under age 65 who have younger-onset Alzheimer's. By
2050, the number of people age 65 and older with Alzheimer's
dementia is projected to increase to 13.8 million Americans.
(2) As many as half of the estimated 5,100,000 American
seniors with Alzheimer's disease and other dementias have never
received a diagnosis.
(3) In 2019, it is estimated that Alzheimer's and related
dementias will have cost the Medicare and Medicaid programs
$195 billion. By 2050, it is estimated that these direct costs
will increase to as much as $1.1 trillion.
(4) Alzheimer's exacts an emotional and physical toll on
caregivers, resulting in higher incidence of heart disease,
cancer, depression, and other health consequences.
(5) Alzheimer's disease disproportionately impacts women
and people of color. Women are twice as likely to develop
Alzheimer's as they are breast cancer. African Americans are
about two times more likely than White Americans to have
Alzheimer's disease and other dementias. Latinos are about one
and one-half times more likely than White Americans to have
Alzheimer's disease and other dementias. According to the
Centers for Disease Control and Prevention, among people ages
65 and older, African Americans have the highest prevalence of
Alzheimer's disease and related dementias (13.8 percent),
followed by Hispanics (12.2 percent), and non-Hispanic Whites
(10.3 percent), American Indian and Alaska Natives (9.1
percent), and Asian and Pacific Islanders (8.4 percent). This
higher prevalence translates into a higher death rate:
Alzheimer's deaths increased 55 percent among all Americans
between 1999 and 2014, while the number was 107 percent for
Latinos and 99 percent for African Americans.
(6) There are evidence-based, reliable, and NIH-identified
cognitive impairment detection tools available at the National
Institute on Aging's Alzheimer's and Dementia Resources for
Professionals website that must replace detection by direct
observation in the Medicare Annual visits and Welcome to
Medicare visits. The NIH-identified tools will allow for
appropriate follow-up instead of delaying diagnosis or impeding
opportunities for patients to access timely treatment options,
including clinical trial participation.
(7) An early, documented diagnosis, communicated to the
patient and caregiver, enables early access to care planning
services and available medical and nonmedical treatments, and
optimizes patients' ability to build a care team, participate
in support services, and enroll in clinical trials.
(8) African Americans represent 13 percent of the
population of the United States but only 5 percent of clinical
trial participants, and Latinos represent 17 percent of the
population of the United States but less than one percent of
clinical trial participants. Further, Latinos and African
Americans account for only 3.5 percent and 1.2 percent,
respectively, of principal investigators supported by the
National Institutes of Health funding, limiting this
perspective in research. Better recruitment and trial designs
are critical to addressing innovation in Alzheimer's generally,
including the underrepresentation of African Americans and
Latinos.
(9) Inability to identify eligible patients at the earliest
stages of disease is a substantial impediment to efficient
research toward Alzheimer's disease prevention, treatment, and
cure.
(10) Advancing treatment options to prevent, treat, or cure
Alzheimer's is an urgent national priority.
(11) A paradigm shift to drive synergies between high-value
patient care, caregiver support, brain health promotion, and
research initiatives is our best hope for preventing, treating,
and curing Alzheimer's disease.
SEC. 2. COGNITIVE IMPAIRMENT DETECTION BENEFIT IN THE MEDICARE ANNUAL
WELLNESS VISIT AND INITIAL PREVENTIVE PHYSICAL
EXAMINATION.
(a) Annual Wellness Visit.--
(1) In general.--Section 1861(hhh)(2) of the Social
Security Act (42 U.S.C. 1395x(hhh)(2)) is amended--
(A) by striking subparagraph (D) and inserting the
following:
``(D) Detection of any cognitive impairment or
progression of cognitive impairment that shall--
``(i) be performed using a cognitive
impairment detection tool identified by the
National Institute on Aging as meeting its
criteria for selecting instruments to detect
cognitive impairment in the primary care
setting, and other validated cognitive
detection tools as the Secretary determines;
``(ii) include documentation of the tool
used for detecting cognitive impairment and
results of the assessment in the patient's
medical record; and
``(iii) take into consideration the tool
used, and results of, any previously performed
cognitive impairment detection assessment.'';
(B) by redesignating subparagraph (I) as
subparagraph (J); and
(C) by inserting after subparagraph (H) the
following new subparagraph:
``(I) Referral of patients with detected cognitive
impairment or potential cognitive decline to--
``(i) appropriate Alzheimer's disease and
dementia diagnostic services, including amyloid
positron emission tomography, and other
medically accepted diagnostic tests that the
Secretary determines are safe and effective;
``(ii) specialists and other clinicians
with expertise in diagnosing or treating
Alzheimer's disease and related dementias;
``(iii) available community-based services,
including patient and caregiver counseling and
social support services; and
``(iv) appropriate clinical trials.''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply to annual wellness visits furnished on or after
January 1, 2020.
(b) Initial Preventive Physical Examination.--
(1) In general.--Section 1861(ww)(1) of the Social Security
Act (42 U.S.C. 1395x(ww)(1)) is amended by striking ``agreement
with the individual, and'' and inserting ``agreement with the
individual, detection of any cognitive impairment or
progression of cognitive impairment as described in
subparagraph (D) of subsection (hhh)(2) and referrals as
described in subparagraph (I) of such subsection, and''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply to initial preventive physical examinations
furnished on or after January 1, 2020.
SEC. 3. MEDICARE QUALITY PAYMENT PROGRAM.
Not later than January 1, 2020, the Secretary of Health and Human
Services shall implement Medicare policies under title XVIII of the
Social Security Act, including quality measures and Medicare Advantage
plan rating and risk adjustment mechanisms, that reflect the public
health imperative of--
(1) promoting healthy brain lifestyle choices;
(2) identifying and responding to patient risk factors for
Alzheimer's disease and related dementias; and
(3) incentivizing providers for--
(A) adequate and reliable cognitive impairment
detection in the primary care setting, that is
documented in the patient's electronic health record
and communicated to the patient;
(B) timely Alzheimer's disease diagnosis; and
(C) appropriate care planning services, including
identification of, and communication with patients and
caregivers about, the potential for clinical trial
participation.
SEC. 4. REPORT TO CONGRESS ON IMPLEMENTATION OF THIS ACT.
Not later than 3 years after the date of the enactment of this Act,
the Secretary of Health and Human Services shall submit a report to
Congress on the implementation of the provisions of, and amendments
made by, this Act, including--
(1) the increased use of validated tools for detection of
cognitive impairment and Alzheimer's disease;
(2) utilization of Alzheimer's disease diagnostic and care
planning services; and
(3) outreach efforts in the primary care and patient
communities.
SEC. 5. STUDY AND REPORT ON REGULATORY AND LEGISLATIVE CHANGES OR
REFINEMENTS THAT WOULD ACCELERATE ALZHEIMER'S DISEASE
RESEARCH PROGRESS.
(a) In General.--The Comptroller General of the United States (in
this section referred to as the ``Comptroller General'') shall conduct
a study on regulatory and legislative changes or refinements that would
accelerate Alzheimer's disease research progress. In conducting such
study, the Comptroller General shall consult with interested
stakeholders, including industry leaders, researchers, clinical
experts, patient advocacy groups, caregivers, patients, providers, and
State leaders. Such study shall include an analysis of innovative
public-private partnerships, innovative financing tools, incentives,
and other mechanisms to enhance the quality of care for individuals
diagnosed with Alzheimer's disease, reduce the emotional, financial,
and physical burden on familial care partners, and accelerate
development of preventative, curative, and disease-modifying therapies.
(b) Report.--Not later than 1 year after the date of the enactment
of this Act, the Comptroller General shall submit to Congress a report
containing the results of the study conducted under subsection (a),
together with recommendations for such legislation and administrative
action as the Comptroller General determines appropriate.
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