Health Outcomes, Planning, and Education for Alzheimer's Act

Summary: Health Outcomes, Planning, and Education for Alzheimer's Act - Amends title XVIII (Medicare) of the Social Security Act to provide for comprehensive Alzheimer's disease diagnosis and services.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Health Outcomes, Planning, and 
Education for Alzheimer's Act''.

SEC. 2. FINDINGS AND PURPOSE.

    (a) Findings.--Congress makes the following findings:
            (1) As many as half of the estimated 5.2 million Americans 
        with Alzheimer's disease have never received a diagnosis.
            (2) An early and documented diagnosis and access to care 
        planning services leads to better outcomes for individuals with 
        Alzheimer's disease and other dementias and their caregivers.
            (3) Combining the existing Medicare benefits of a 
        diagnostic evaluation and care planning into a single package 
        of services would help ensure that individuals receive an 
        appropriate diagnosis as well as critical information about the 
        disease and available care options, which leads to better 
        outcomes.
            (4) An accurate diagnosis allows for better management of 
        other known chronic conditions and more efficient utilization 
        of medical resources, including reducing complications and the 
        number of costly emergency room visits and hospitalizations.
            (5) A formal diagnosis allows individuals and their 
        caregivers to have access to available medical and non-medical 
        treatments, build a care team, participate in support services, 
        and enroll in clinical trials.
            (6) Undertaking the diagnostic process potentially allows 
        cognitive impairment to be reversed, as the cognitive 
        impairment of nine percent of individuals experiencing 
        dementia-like symptoms is due to a potentially reversible 
        cause, such as depression or vitamin deficiency.
    (b) Purpose.--The purpose of this Act is to increase diagnosis of 
Alzheimer's disease and related dementias, leading to better care and 
outcomes for Americans living with Alzheimer's disease and related 
dementias.

SEC. 3. MEDICARE COVERAGE OF COMPREHENSIVE ALZHEIMER'S DISEASE 
              DIAGNOSIS AND SERVICES.

    (a) In General.--Section 1861 of the Social Security Act (42 U.S.C. 
1395x) is amended--
            (1) in subsection (s)(2)--
                    (A) by striking ``and'' at the end of subparagraph 
                (EE);
                    (B) by adding ``and'' at the end of subparagraph 
                (FF); and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(GG) comprehensive Alzheimer's disease diagnosis and 
        services (as defined in subsection (iii));''; and
            (2) by adding at the end the following new subsection:

       ``Comprehensive Alzheimer's Disease Diagnosis and Services

    ``(iii)(1) The term `comprehensive Alzheimer's disease diagnosis 
and services' means the services described in paragraph (2) furnished 
to an individual--
            ``(A) who does not already have a diagnosis of Alzheimer's 
        disease; and
            ``(B) for whom a physician or a practitioner described in 
        clause (i), (iv), or (v) of section 1842(b)(18)(C), in a 
        medical setting such as a physician's office, a hospital, a 
        skilled nursing facility, a community health center, or another 
        similar medical setting--
                    ``(i) has detected the individual may have a 
                cognitive impairment or dementia; and
                    ``(ii) pursuant to such detection, has determined a 
                diagnostic evaluation for Alzheimer's disease is 
                needed.
    ``(2) The services described in this paragraph are the following:
            ``(A) A diagnostic evaluation, including referral to a 
        specialist if recommended.
            ``(B) If the individual is diagnosed with Alzheimer's 
        disease under the diagnostic evaluation under subparagraph (A), 
        care planning services (with the individual, with the personal 
        representative of the individual, or with one or more family 
        caregivers of the individual with or without the presence of 
        the individual), including assistance understanding the 
        diagnosis as well as the medical and non-medical options for 
        ongoing treatment, services, and supports, and information 
        about how to obtain such treatments, services, and supports. 
        Such care planning services for individuals diagnosed with 
        Alzheimer's disease should take into consideration and address 
        other co-morbid chronic conditions.
            ``(C) Medical record documentation, with respect to an 
        individual, of the diagnostic evaluation under subparagraph 
        (A), the diagnosis, and any care planning services under 
        subparagraph (B).
    ``(3) In this subsection--
            ``(A) the term `Alzheimer's disease' means Alzheimer's 
        disease and related dementias; and
            ``(B) the term `personal representative' means, with 
        respect to an individual, a person legally authorized to make 
        health care decisions on such individual's behalf.''.
    (b) Payment.--Section 1833(a)(1) of the Social Security Act (42 
U.S.C. 1395l(a)(1)) is amended by striking ``and'' before ``(Z)'' and 
inserting before the semicolon at the end the following: ``, and (AA) 
with respect to comprehensive Alzheimer's disease diagnosis and 
services (as defined in section 1861(iii)), the amount paid shall be an 
amount equal to 80 percent of the amount determined under a fee 
schedule designated by the Secretary''.
    (c) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1 of the year following 
the year which includes the date of the enactment of this Act.