[Congressional Record Volume 164, Number 196 (Wednesday, December 12, 2018)]
[Senate]
[Pages S7526-S7527]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    BUILDING OUR LARGEST DEMENTIA INFRASTRUCTURE FOR ALZHEIMER'S ACT

  Mr. GARDNER. Mr. President, I ask unanimous consent that the Senate 
proceed to the immediate consideration of Calendar No. 694, S. 2076.
  The PRESIDING OFFICER. The clerk will report the bill by title.
  The senior assistant legislative clerk read as follows:

       A bill to amend the Public Health Service Act to authorize 
     the expansion of activities related to Alzheimer's disease, 
     cognitive decline, and brain health under the Alzheimer's 
     Disease and Healthy Aging Program, and for other purposes.

  There being no objection, the Senate proceeded to consider the bill, 
which had been reported from the Committee on Health, Education, Labor, 
and Pensions, with an amendment to strike all after the enacting clause 
and insert in lieu thereof the following:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Building Our Largest 
     Dementia Infrastructure for Alzheimer's Act'' or the ``BOLD 
     Infrastructure for Alzheimer's Act''.

     SEC. 2. PROMOTION OF PUBLIC HEALTH KNOWLEDGE AND AWARENESS OF 
                   ALZHEIMER'S DISEASE, COGNITIVE DECLINE, AND 
                   BRAIN HEALTH UNDER THE ALZHEIMER'S DISEASE AND 
                   HEALTHY AGING PROGRAM.

       Part K of title III of the Public Health Service Act (42 
     U.S.C. 280c et seq.) is amended--
       (1) in the part heading, by adding ``AND PUBLIC HEALTH 
     PROGRAMS FOR DEMENTIA'' at the end; and
       (2) in subpart II--
       (A) by striking the subpart heading and inserting the 
     following:

``Subpart II--Programs With Respect to Alzheimer's Disease and Related 
                            Dementias''; and

       (B) by striking section 398A (42 U.S.C. 280c-4) and 
     inserting the following:

     ``SEC. 398A. PROMOTION OF PUBLIC HEALTH KNOWLEDGE AND 
                   AWARENESS OF ALZHEIMER'S DISEASE AND RELATED 
                   DEMENTIAS.

       ``(a) Alzheimer's Disease and Related Dementias Public 
     Health Centers of Excellence.--
       ``(1) In general.--The Secretary, in coordination with the 
     Director of the Centers for Disease Control and Prevention 
     and the heads of other agencies as appropriate, shall award 
     grants, contracts, or cooperative agreements to eligible 
     entities, such as institutions of higher education, State, 
     tribal, and local health departments, Indian tribes, tribal 
     organizations, associations, or other appropriate entities 
     for the establishment or support of regional centers to 
     address Alzheimer's disease and related dementias by--
       ``(A) advancing the awareness of public health officials, 
     health care professionals, and the public, on the most 
     current information and research related to Alzheimer's 
     disease and related dementias, including cognitive decline, 
     brain health, and associated health disparities;
       ``(B) identifying and translating promising research 
     findings, such as findings from research and activities 
     conducted or supported by the National Institutes of Health, 
     including Alzheimer's Disease Research Centers authorized by 
     section 445, into evidence-based programmatic interventions 
     for populations with Alzheimer's disease and related 
     dementias and caregivers for such populations; and
       ``(C) expanding activities, including through public-
     private partnerships related to Alzheimer's disease and 
     related dementias and associated health disparities.
       ``(2) Requirements.--To be eligible to receive a grant, 
     contract, or cooperative agreement under this subsection, an 
     entity shall submit to the Secretary an application 
     containing such agreements and information as the Secretary 
     may require, including a description of how the entity will--
       ``(A) coordinate, as applicable, with existing Federal, 
     State, and tribal programs related to Alzheimer's disease and 
     related dementias;
       ``(B) examine, evaluate, and promote evidence-based 
     interventions for individuals with Alzheimer's disease and 
     related dementias, including underserved populations with 
     such conditions, and those who provide care for such 
     individuals; and
       ``(C) prioritize activities relating to--
       ``(i) expanding efforts, as appropriate, to implement 
     evidence-based practices to address Alzheimer's disease and 
     related dementias, including through the training of State, 
     local, and tribal public health officials and other health 
     professionals on such practices;
       ``(ii) supporting early detection and diagnosis of 
     Alzheimer's disease and related dementias;
       ``(iii) reducing the risk of potentially avoidable 
     hospitalizations of individuals with Alzheimer's disease and 
     related dementias;
       ``(iv) reducing the risk of cognitive decline and cognitive 
     impairment associated with Alzheimer's disease and related 
     dementias;
       ``(v) enhancing support to meet the needs of caregivers of 
     individuals with Alzheimer's disease and related dementias;
       ``(vi) reducing health disparities related to the care and 
     support of individuals with Alzheimer's disease and related 
     dementias;
       ``(vii) supporting care planning and management for 
     individuals with Alzheimer's disease and related dementias; 
     and
       ``(viii) supporting other relevant activities identified by 
     the Secretary or the Director of the Centers for Disease 
     Control and Prevention, as appropriate.
       ``(3) Considerations.--In awarding grants, contracts, and 
     cooperative agreements under this subsection, the Secretary 
     shall consider, among other factors, whether the entity--
       ``(A) provides services to rural areas or other underserved 
     populations;
       ``(B) is able to build on an existing infrastructure of 
     services and public health research; and
       ``(C) has experience with providing care or caregiver 
     support, or has experience conducting research related to 
     Alzheimer's disease and related dementias.
       ``(4) Distribution of awards.--In awarding grants, 
     contracts, or cooperative agreements under this subsection, 
     the Secretary, to the extent practicable, shall ensure 
     equitable distribution of awards based on geographic area, 
     including consideration of rural areas, and the burden of the 
     disease within sub-populations.
       ``(5) Data reporting and program oversight.--With respect 
     to a grant, contract, or cooperative agreement awarded under 
     this subsection, not later than 90 days after the end of the 
     first year of the period of assistance, and annually 
     thereafter for the duration of the grant, contract, or 
     agreement (including the duration of any renewal period as 
     provided for under paragraph (5)), the entity shall submit 
     data, as appropriate, to the Secretary regarding--
       ``(A) the programs and activities funded under the grant, 
     contract, or agreement; and
       ``(B) outcomes related to such programs and activities.
       ``(b) Improving Data on State and National Prevalence of 
     Alzheimer's Disease and Related Dementias.--
       ``(1) In general.--The Secretary shall, as appropriate, 
     improve the analysis and timely reporting of data on the 
     incidence and prevalence of Alzheimer's disease and related 
     dementias. Such data may include, as appropriate, information 
     on cognitive decline, caregiving, and health disparities 
     experienced by individuals with cognitive decline and their 
     caregivers. The Secretary may award grants, contracts, or 
     cooperative agreements to eligible entities for activities 
     under this paragraph.
       ``(2) Eligibility.--To be eligible to receive a grant, 
     contract, or cooperative agreement under this subsection, an 
     entity shall be a public or nonprofit private entity, 
     including institutions of higher education, State, local, and 
     tribal health departments, and Indian tribes and tribal 
     organizations, and submit to the Secretary an application at 
     such time, in such manner, and containing such information as 
     the Secretary may require.
       ``(3) Data sources.--The analysis, timely public reporting, 
     and dissemination of data under this subsection may be 
     carried out using data sources such as the following:
       ``(A) The Behavioral Risk Factor Surveillance System.
       ``(B) The National Health and Nutrition Examination Survey.
       ``(C) The National Health Interview Survey.
       ``(c) Improved Coordination.--The Secretary shall ensure 
     that activities and programs related to dementia under this 
     section do not unnecessarily duplicate activities and 
     programs of other agencies and offices within the Department 
     of Health and Human Services.''.

[[Page S7527]]

  


     SEC. 3. SUPPORTING STATE PUBLIC HEALTH PROGRAMS RELATED TO 
                   ALZHEIMER'S DISEASE AND RELATED DEMENTIAS.

       Section 398 of the Public Health Service Act (42 U.S.C. 
     280c-3) is amended--
       (1) in the section heading, by striking ``establishment of 
     program'' and inserting ``COOPERATIVE AGREEMENTS TO STATES 
     AND PUBLIC HEALTH DEPARTMENTS FOR ALZHEIMER'S DISEASE AND 
     RELATED DEMENTIAS'';
       (2) by striking subsection (a) and inserting the following:
       ``(a) In General.--The Secretary, in coordination with the 
     Director of the Centers for Disease Control and Prevention 
     and the heads of other agencies, as appropriate, shall award 
     cooperative agreements to health departments of States, 
     political subdivisions of States, and Indian tribes and 
     tribal organizations, to address Alzheimer's disease and 
     related dementias, including by reducing cognitive decline, 
     helping meet the needs of caregivers, and addressing unique 
     aspects of Alzheimer's disease and related dementias to 
     support the development and implementation of evidence-based 
     interventions with respect to--
       ``(1) educating and informing the public, based on 
     evidence-based public health research and data, about 
     Alzheimer's disease and related dementias;
       ``(2) supporting early detection and diagnosis;
       ``(3) reducing the risk of potentially avoidable 
     hospitalizations for individuals with Alzheimer's disease and 
     related dementias;
       ``(4) reducing the risk of cognitive decline and cognitive 
     impairment associated with Alzheimer's disease and related 
     dementias;
       ``(5) improving support to meet the needs of caregivers of 
     individuals with Alzheimer's disease and related dementias;
       ``(6) supporting care planning and management for 
     individuals with Alzheimer's disease and related dementias.
       ``(7) supporting other relevant activities identified by 
     the Secretary or the Director of the Centers for Disease 
     Control and Prevention, as appropriate''.; and
       (3) by striking subsection (b);
       (4) by redesignating subsection (c) as subsection (g);
       (5) by inserting after subsection (a), the following:
       ``(b) Preference.--In awarding cooperative agreements under 
     this section, the Secretary shall give preference to 
     applications that focus on addressing health disparities, 
     including populations and geographic areas that have the 
     highest prevalence of Alzheimer's disease and related 
     dementias.
       ``(c) Eligibility.--To be eligible to receive a cooperative 
     agreement under this section, an eligible entity (pursuant to 
     subsection (a)) shall prepare and submit to the Secretary an 
     application at such time, in such manner, and containing such 
     information as the Secretary may require, including a plan 
     that describes--
       ``(1) how the applicant proposes to develop or expand, 
     programs to educate individuals through partnership 
     engagement, workforce development, guidance and support for 
     programmatic efforts, and evaluation with respect to 
     Alzheimer's disease and related dementias, and in the case of 
     a cooperative agreement under this section, how the applicant 
     proposes to support other relevant activities identified by 
     the Secretary or Director of the Centers for Disease Control 
     and Prevention, as appropriate.
       ``(2) the manner in which the applicant will coordinate 
     with Federal, tribal, and State programs related to 
     Alzheimer's disease and related dementias, and appropriate 
     State, tribal, and local agencies, as well as other relevant 
     public and private organizations or agencies; and
       ``(3) the manner in which the applicant will evaluate the 
     effectiveness of any program carried out under the 
     cooperative agreement.
       ``(d) Matching Requirement.--Each health department that is 
     awarded a cooperative agreement under subsection (a) shall 
     provide, from non-Federal sources, an amount equal to 30 
     percent of the amount provided under such agreement (which 
     may be provided in cash or in-kind) to carry out the 
     activities supported by the cooperative agreement.
       ``(e) Waiver Authority.--The Secretary may waive all or 
     part of the matching requirement described in subsection (d) 
     for any fiscal year for--
       ``(1) a health department of a State, political subdivision 
     of a State, or Indian tribe and tribal organization, if the 
     Secretary determines that applying such matching requirement 
     would result in serious hardship or an inability to carry out 
     the purposes of the cooperative agreement awarded to such 
     health department of a State, political subdivision of a 
     State, or Indian tribe and tribal organization; or
       ``(2) a health department of a State, political subdivision 
     of a State, or Indian tribe and tribal organization located 
     in a rural area or frontier area.'';
       (6) in subsection (f) (as so redesignated), by striking 
     ``grant'' and inserting ``cooperative agreement''; and
       (7) by adding at the end the following:
       ``(f) Non-duplication of Effort.--The Secretary shall 
     ensure that activities under any cooperative agreement 
     awarded under this subpart do not unnecessarily duplicate 
     efforts of other agencies and offices within the Department 
     of Health and Human Services related to--
       ``(1) activities of centers of excellence with respect to 
     Alzheimer's disease and related dementias described in 
     section 398A; and
       ``(2) activities of public health departments with respect 
     to Alzheimer's disease and related dementias described in 
     this section.''.

     SEC. 4. ADDITIONAL PROVISIONS.

       Section 398B of the Public Health Service Act (42 U.S.C. 
     280c-5) is amended--
       (1) in subsection (a)--
       (A) by inserting ``or cooperative agreement'' after 
     ``grant'' each place that such appears;
       (B) by striking ``section 398(a) to a State unless the 
     State'' and inserting ``sections 398 or 398A to an entity 
     unless the entity''; and
       (C) by striking ``10'' and inserting ``5'';
       (2) by striking subsection (b);
       (3) by redesignating subsections (c) and (d) as subsections 
     (b) and (c), respectively;
       (4) in subsection (b) (as so redesignated)--
       (A) in the matter preceding paragraph (1), by striking 
     ``section 398(a) to a State unless the State'' and inserting 
     ``sections 398 or 398A to an entity unless the entity'';
       (B) in paragraph (1), by striking ``expenditures required 
     in subsection (b);'' and inserting ``expenditures;'';
       (5) in subsection (c) (as so redesignated)--
       (A) in paragraph (1)--
       (i) by striking ``each demonstration project for which a 
     grant'' and inserting ``the activities for which an award''; 
     and
       (ii) by striking ``section 398(a)'' and inserting 
     ``sections 398 or 398A''; and
       (B) in paragraph (2), by striking ``6 months'' and 
     inserting ``1 year'';
       (6) by inserting after subsection (c) (as so redesignated), 
     the following:
       ``(d) Definition.--In this subpart, the terms `Indian 
     tribe' and `tribal organization' have the meanings given such 
     terms in section 4 of the Indian Health Care Improvement 
     Act.''; and
       (7) in subsection (e), by striking ``$5,000,000 for each of 
     the fiscal years 1988 through 1990'' and all that follows 
     through ``2002'' and inserting ``$20,000,000 for each of 
     fiscal years 2020 through 2024''.

  Mr. GARDNER. Mr. President, I ask unanimous consent that the Collins 
amendment at the desk be considered and agreed to, that the committee-
reported substitute amendment, as amended, be agreed to, and the bill, 
as amended, be considered read a third time.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment (No. 4104) was agreed to as follows:

          (Purpose: To clarify provisions relating to waivers)

       Beginning on page 28, line 23, strike ``year for--'' and 
     all that follows through line 9 on page 29, and insert the 
     following: `` `year for a health department of a State, 
     political subdivision of a State, or Indian tribe and tribal 
     organization (including those located in a rural area or 
     frontier area), if the Secretary determines that applying 
     such matching requirement would result in serious hardship or 
     an inability to carry out the purposes of the cooperative 
     agreement awarded to such health department of a State, 
     political subdivision of a State, or Indian tribe and tribal 
     organization.';''.

  The committee-reported amendment in the nature of a substitute, as 
amended, was agreed to.
  The bill was ordered to be engrossed for a third reading and was read 
the third time.
  Mr. GARDNER. Mr. President, I know of no further debate on the bill.
  The PRESIDING OFFICER. Is there further debate on the bill?
  Hearing none, the question is, Shall the bill pass?
  The bill (S. 2076), as amended, was passed.
  Mr. GARDNER. Mr. President, I ask unanimous consent the motion to 
reconsider be considered made and laid upon the table.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The bill (S. 2076), as amended, is printed in the Record of December 
21, 2018, on page S. 8018.)


 =========================== NOTE =========================== 

  
  On page S7527, December 12, 2018, in the third column, the 
following appears: The PRESIDING OFFICER. Without objection, it is 
so ordered.
  
  The online Record has been corrected to read: The PRESIDING 
OFFICER. Without Objection, it is so ordered. (The bill (S. 2076), 
as amended, is printed in the Record of December 21, 2018, on page 
S. 8018.)


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