    [United States Statutes at Large, Volume 132, 115th Congress, 2nd Session]
    [From the U.S. Government Publishing Office, www.gpo.gov]

    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. <>

    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 ``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--

    [[Page 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 <> .--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 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 <> .--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 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 <> .--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.

    [[Page 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 <> .--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 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.