[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9823 Introduced in House (IH)]
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119th CONGRESS
2d Session
H. R. 9823
To amend title XXVII of the Public Health Service Act and title XIX of
the Social Security Act to require coverage of Alzheimer's biomarker
testing under group health plans, group and individual health insurance
coverage, and the Medicaid program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 22, 2026
Mr. Auchincloss (for himself and Mr. Ciscomani) introduced the
following bill; which was referred to the Committee on Energy and
Commerce
_______________________________________________________________________
A BILL
To amend title XXVII of the Public Health Service Act and title XIX of
the Social Security Act to require coverage of Alzheimer's biomarker
testing under group health plans, group and individual health insurance
coverage, and the Medicaid program.
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 Early Detection Act of
2026''.
SEC. 2. REQUIRING COVERAGE OF ALZHEIMER'S BIOMARKER TESTING UNDER GROUP
HEALTH PLANS, GROUP AND INDIVIDUAL HEALTH INSURANCE
COVERAGE, AND THE MEDICAID PROGRAM.
(a) Private Insurance.--
(1) In general.--Part A of title XXVII of the Public Health
Service Act (42 U.S.C. 300gg-11 et seq.) is amended by adding
at the end the following new section:
``SEC. 2730. REQUIRED COVERAGE OF ALZHEIMER'S BIOMARKER TESTING.
``(a) In General.--A group health plan and a health insurance
issuer offering group or individual health insurance coverage shall
provide benefits under such plan or coverage for Alzherimer's biomarker
testing.
``(b) Manner of Coverage.--A group health plan and a health
insurance issuer offering group or individual health insurance coverage
shall ensure that, with respect to testing for which benefits are
required to be provided under such plan or coverage under subsection
(a)--
``(1) the financial requirements applicable to such testing
are no more restrictive than the predominant financial
requirements applied to substantially all medical and surgical
benefits covered by the plan or coverage and there are no
separate cost-sharing requirements that are applicable only
with respect to such testing;
``(2) the treatment limitations applicable to such testing
are no more restrictive than the predominant treatment
limitations applied to substantially all medical and surgical
benefits covered by the plan or coverage and there are no
separate treatment limitations that are applicable only with
respect to such testing;
``(3) in the case such plan or coverage imposes any prior
authorization requirement with respect to such testing, the
plan or coverage makes a determination with respect to a
request for such authorization not later than 72 hours (or 24
hours, in the case the provider submitting such request attests
that delay of such testing beyond 24 hours would place an
individual's life or health at serious risk) after receiving
such request;
``(4) in the case such plan or coverage fails to make a
determination with respect to a prior authorization request for
such testing in accordance with paragraph (3), the plan or
coverage treats such request as having been approved;
``(5) the plan or coverage does not apply any step therapy
requirement prior to providing benefits for such testing; and
``(6) such benefits are provided in a manner that promotes
equitable access, including for rural and underserved
populations, and supports the use of minimally invasive testing
where clinically appropriate.
``(c) Alzheimer's Biomarker Testing Defined.--
``(1) In general.--For purposes of this section, the term
`Alzheimer's biomarker testing' means the analysis of an
individual's tissue, blood, or other biospecimen for the
presence of a biomarker, including single-analyte tests,
multiplex panel tests, protein expression, and whole genome,
whole exome, and whole transcriptome sequencing, furnished for
a purpose specified in paragraph (2)--
``(A) in accordance with any Food and Drug
Administration labeling indication;
``(B) to determine eligibility for, or to manage
treatment of Alzheimer's disease with, a drug approved
by the Food and Drug Administration;
``(C) in accordance with any national coverage
determination under title XVIII of the Social Security
Act; or
``(D) in accordance with applicable clinical
practice guidelines or consensus statements relating to
the diagnosis of, treatment selection for, management
of, or monitoring of Alzheimer's disease.
``(2) Purposes specified.--For purposes of paragraph (1),
the purposes specified in this paragraph are the early
detection, risk stratification, diagnosis, treatment,
appropriate management, or ongoing monitoring of Alzheimer's
disease.
``(3) Additional definitions.--For purposes of paragraph
(1):
``(A) Biomarker.--The term `biomarker' means a
characteristic that is objectively measured and
evaluated as an indicator of normal biological
processes, pathogenic processes, or pharmacologic
responses to a specific therapeutic intervention,
including gene-drug interactions.
``(B) Consensus statement.--The term `consensus
statement' means statements developed by an
independent, multidisciplinary panel of experts that
uses a transparent methodology and reporting structure
and include a conflict-of-interest policy.
``(C) Clinical practice guideline.--The term
`clinical practice guideline' means an evidence-based
guideline developed by an independent organization or
medical professional society that uses a transparent
methodology and reporting structure and includes a
conflict-of-interest policy.''.
(2) Effective date.--The amendment made by this subsection
shall apply with respect to plan years beginning on or after
the date that is 1 year after the date of the enactment of this
Act.
(b) Medicaid.--
(1) Inclusion as medical assistance.--Section 1905(a) of
the Social Security Act (42 U.S.C. 1396d(a)) is amended--
(A) in paragraph (31), by striking ``and'' at the
end;
(B) by redesignating paragraph (32) as paragraph
(33); and
(C) by inserting after paragraph (31) the following
new paragraph:
``(32) biomarker testing (as defined in section 2730(c) of
the Public Health Service Act); and''.
(2) Mandatory coverage.--Section 1902(a)(10)(A) of the
Social Security Act (42 U.S.C. 1395a(a)(10)(A)) is amended, in
the matter preceding clause (i), by striking ``and (30)'' and
inserting ``(30), and (32)''.
(3) Manner of coverage.--Section 1902(a) of the Social
Security Act (42 U.S.C. 1396a(a)) is amended--
(A) in paragraph (89), by striking ``and'' at the
end;
(B) in paragraph (90), by striking the period at
the end and inserting ``; and''; and
(C) by inserting after paragraph (90) the following
new paragraph:
``(91) provide, in the case of biomarker testing (as
defined in subsection (c) of section 2730 of the Public Health
Service Act), for coverage of such testing in the same manner
as such testing is required to be covered by a group health
plan or health insurance issuer offering group or individual
health insurance coverage under subsection (b) of such
section.''.
(4) Effective date.--The amendments made by this subsection
shall apply with respect to calendar quarters beginning on or
after the date that is 1 year after the date of the enactment
of this Act.
(c) Report.--Not later than 1 year after the date of the enactment
of this Act, and on an annual basis for the 2 succeeding years, the
Director of the National Institutes of Health shall, through contract
with the National Academies of Sciences, Engineering, and Medicine,
conduct a study and submit to Congress a report on the value of
biomarker testing in detecting and treating Alzheimer's disease.
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