[115th Congress Public Law 406]
[From the U.S. Government Publishing Office]



[[Page 5361]]

    BUILDING OUR LARGEST DEMENTIA INFRASTRUCTURE FOR ALZHEIMER'S ACT

[[Page 132 STAT. 5362]]

Public Law 115-406
115th Congress

                                 An Act


 
  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. <<NOTE: Dec. 31, 2018 -  [S. 2076]>> 

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, <<NOTE: Building Our 
Largest Dementia Infrastructure for Alzheimer's Act.>> 
SECTION 1. <<NOTE: 42 USC 201 note.>>  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 <<NOTE: Coordination. Grants. Contracts.>> .--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--

[[Page 132 STAT. 5363]]

                    ``(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 <<NOTE: Application.>> .--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--

[[Page 132 STAT. 5364]]

                    ``(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 <<NOTE: Deadline.>> .--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 <<NOTE: Analysis.>> .--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 <<NOTE: Application.>> .--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 132 STAT. 5365]]

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 <<NOTE: Coordination.>> .--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 <<NOTE: Application. Plan.>> .--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.

[[Page 132 STAT. 5366]]

            ``(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 <<NOTE: Determination.>> .--The Secretary may 
waive all or part of the matching requirement described in subsection 
(d) for any fiscal 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.'';
            (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;'';

[[Page 132 STAT. 5367]]

            (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''.

    Approved December 31, 2018.

LEGISLATIVE HISTORY--S. 2076:
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CONGRESSIONAL RECORD, Vol. 164 (2018):
            Dec. 12, considered and passed Senate.
            Dec. 19, considered and passed House.

                                  <all>