II 

118TH CONGRESS 

1ST SESSION S. 626 

To recommend that the Center for Medicare and Medicaid Innovation test 

the effect of a dementia care management model, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 2, 2023 

Ms. STABENOW (for herself and Mrs. CAPITO) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To recommend that the Center for Medicare and Medicaid 

Innovation test the effect of a dementia care management model, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Comprehensive Care 

5 for Alzheimer’s Act’’. 

6 SEC. 2. CMI TESTING OF DEMENTIA CARE MANAGEMENT. 

7 Section 1115A of the Social Security Act (42 U.S.C. 

8 1315a) is amended— 

9 (1) in subsection (b)(2)(B), by adding at the 

10 end the following new clause: 


kjohnson on DSK79L0C42PROD with BILLS
2 

•S 626 IS

1 ‘‘(xxviii) Furnishing comprehensive 

2 care management services to eligible indi3 viduals with Alzheimer’s disease or a re4 lated dementia through a Dementia Care 

5 Management Model, as described in sub6 section (h).’’; and 

7 (2) by adding at the end the following new sub8 section: 

9 ‘‘(h) DEMENTIA CARE MANAGEMENT MODEL.— 

10 ‘‘(1) DESCRIPTION OF MODEL AND REQUIRE11 MENTS.— 

12 ‘‘(A) IN GENERAL.—The Dementia Care 

13 Management Model described in this subsection 

14 is a model under which payments are made 

15 under title XVIII to eligible entities that fur16 nish comprehensive care management services 

17 to eligible individuals with Alzheimer’s disease 

18 or a related dementia, in order to test the effec19 tiveness of comprehensive care management 

20 services on patient health, care quality, and 

21 care experience, as well as on unpaid caregivers, 

22 and on reducing spending under title XVIII 

23 without reducing the quality of care. 

24 ‘‘(B) VOLUNTARY PARTICIPATION.—Par25 ticipation under the Dementia Care ManageVerDate Sep 11 2014 00:15 Mar 15, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S626.IS S626

kjohnson on DSK79L0C42PROD with BILLS
3 

•S 626 IS

1 ment Model shall be voluntary with respect to 

2 both eligible individuals and eligible entities. 

3 ‘‘(C) IMPLEMENTATION OF DEMENTIA

4 CARE MANAGEMENT MODEL.— 

5 ‘‘(i) IN GENERAL.—The Secretary 

6 shall— 

7 ‘‘(I) implement the Dementia 

8 Care Management Model as a stand9 alone model; 

10 ‘‘(II) incorporate the Dementia 

11 Care Management Model into the Pri12 mary Care First Model; or 

13 ‘‘(III) incorporate the Dementia 

14 Care Management Model into— 

15 ‘‘(aa) the Primary Care 

16 First Model; and 

17 ‘‘(bb) the Direct Contracting 

18 Model. 

19 ‘‘(ii) ADDITIONAL AUTHORITY.—In 

20 addition to the models described in sub21 clauses (I) through (III) of clause (i), the 

22 Secretary may incorporate the Dementia 

23 Care Management Model into other exist24 ing coordinated care models established 

25 under title XVIII or under this section, inVerDate Sep 11 2014 00:15 Mar 15, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S626.IS S626

kjohnson on DSK79L0C42PROD with BILLS
4 

•S 626 IS

1 cluding accountable care organizations, 

2 value-based purchasing arrangements, and 

3 such other coordinated care models as the 

4 Secretary determines to be appropriate. 

5 ‘‘(2) COMPREHENSIVE CARE MANAGEMENT

6 SERVICES DEFINED.—In this subsection, the term 

7 ‘comprehensive care management services’ means 

8 the following services furnished by an eligible entity 

9 with respect to an eligible individual: 

10 ‘‘(A) CONTINUOUS MONITORING AND AS11 SESSMENT.—An eligible entity shall regularly 

12 assess and continuously monitor the following: 

13 ‘‘(i) Neuropsychiatric symptoms, in14 cluding behavior, physical safety, and func15 tion of an eligible individual. 

16 ‘‘(ii) Comorbidities. 

17 ‘‘(iii) Financial resources and needs. 

18 ‘‘(iv) Caregiver supports and re19 sources, including caregiver education, 

20 training, and support. 

21 ‘‘(v) The well-being of unpaid care22 givers of the eligible individual. 

23 ‘‘(vi) Potential risks and harms of the 

24 eligible individual’s home and environment 


kjohnson on DSK79L0C42PROD with BILLS
5 

•S 626 IS

1 and the need for support for activities of 

2 daily living. 

3 ‘‘(B) ONGOING DEMENTIA CARE PLAN.— 

4 An eligible entity shall develop and implement 

5 an Alzheimer’s disease or related dementia care 

6 plan, including advance care planning as appro7 priate, for an eligible individual. The care plan 

8 shall include patient-centered goals for the eligi9 ble individual as well as goals for unpaid care10 givers of the eligible individual. Such care plan 

11 shall be continuously evaluated and modified as 

12 appropriate. 

13 ‘‘(C) PSYCHOSOCIAL INTERVENTIONS.—An 

14 eligible entity may implement psychosocial 

15 interventions designed to prevent or reduce the 

16 burden of cognitive, functional, behavioral, and 

17 psychological challenges as well as the associ18 ated stress on unpaid caregivers of the eligible 

19 individual. 

20 ‘‘(D) SELF-MANAGEMENT TOOLS.—An eli21 gible entity shall provide self-management tools 

22 to enhance the skills of the unpaid caregiver of 

23 the eligible individual to manage the Alz24 heimer’s disease or related dementia of the eli25 gible individual and to navigate the health care 


kjohnson on DSK79L0C42PROD with BILLS
6 

•S 626 IS

1 system. Such tools shall include training and 

2 support for unpaid caregivers in managing the 

3 limitations of eligible individuals, including edu4 cation, problem solving strategies, care naviga5 tion support, support after discharge from a 

6 hospital or nursing home, and decision-making 

7 support. 

8 ‘‘(E) MEDICATION MANAGEMENT.—An eli9 gible entity shall furnish evidence-based medica10 tion review and management services to an eli11 gible individual, including polypharmacy man12 agement, using a planned process to reduce or 

13 stop medications that may no longer be of ben14 efit or may be having adverse cognitive effects, 

15 prescribing approved medications, and enhanc16 ing adherence to appropriate medications. 

17 ‘‘(F) TREATMENT OF RELATED CONDI18 TIONS.—An eligible entity shall provide inter19 ventions to prevent or treat conditions related 

20 to the Alzheimer’s disease or related dementia 

21 of the eligible individual, such as depression 

22 and delirium. 

23 ‘‘(G) CARE COORDINATION.—An eligible 

24 entity shall provide ongoing care management 

25 services and shall coordinate services and supVerDate Sep 11 2014 00:15 Mar 15, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S626.IS S626

kjohnson on DSK79L0C42PROD with BILLS
7 

•S 626 IS

1 ports among providers of services and suppliers, 

2 as well as social and community resources. 

3 Such services shall include necessary assistance 

4 for referrals to social and community-based or5 ganizations, collaboration with primary care 

6 providers and the interdisciplinary team of the 

7 eligible individual, and support for care transi8 tions and continuity of care. 

9 ‘‘(H) EXCLUSION OF PALLIATIVE CARE

10 AND HOSPICE CARE.—Comprehensive care man11 agement services shall not include palliative 

12 care or hospice care. 

13 ‘‘(I) OTHER SERVICES.—The Secretary 

14 may require or permit other services, as appro15 priate. 

16 ‘‘(3) ELIGIBLE ENTITY DEFINED.—In this sub17 section, the term ‘eligible entity’ means an entity, 

18 such as a health system, hospital, physician or non19 physician group practice, multiple physician prac20 tices, a Federally qualified health center, a rural 

21 health clinic, or an accountable care organization, 

22 that— 

23 ‘‘(A) is qualified to furnish comprehensive 

24 care management services to an eligible indi25 vidual, and any unpaid caregiver of such eligible 


kjohnson on DSK79L0C42PROD with BILLS
8 

•S 626 IS

1 individual, under the Dementia Care Manage2 ment Model either directly or through arrange3 ments with Medicare participating providers of 

4 services and suppliers as well as social and com5 munity-based organizations; 

6 ‘‘(B) is accountable for the quality of com7 prehensive care management services furnished 

8 to an eligible individual under the model; 

9 ‘‘(C) furnishes comprehensive care man10 agement services through an interdisciplinary 

11 team that has at least 1 physician, physician 

12 assistant, nurse practitioner, or advanced prac13 tice nurse who devotes 25 percent or more of 

14 patient contact time to the evaluation and care 

15 of patients with acquired cognitive impairment; 

16 ‘‘(D) furnishes comprehensive care man17 agement services in a culturally appropriate 

18 manner; 

19 ‘‘(E) utilizes a comprehensive, person-cen20 tered care management approach; 

21 ‘‘(F) furnishes wellness and healthcare 

22 planning, including medication review and man23 agement; 

24 ‘‘(G) supports family and caregiver engage25 ment; 


kjohnson on DSK79L0C42PROD with BILLS
9 

•S 626 IS

1 ‘‘(H) provides access to a primary care 

2 provider or a member of the interdisciplinary 

3 team 24 hours a day 7 days a week; 

4 ‘‘(I) has relationships with medical and 

5 nonmedical community-based organizations that 

6 support patients with Alzheimer’s disease or a 

7 related dementia and their caregivers; and 

8 ‘‘(J) meets such other requirements as the 

9 Secretary may determine to be appropriate. 

10 ‘‘(4) ELIGIBLE INDIVIDUAL DEFINED.—In this 

11 subsection, the term ‘eligible individual’ means an 

12 individual— 

13 ‘‘(A) who— 

14 ‘‘(i) is entitled to, or enrolled for, ben15 efits under part A of title XVIII and en16 rolled under part B of such title (including 

17 such an individual who is a dual eligible in18 dividual described in subsection 

19 (a)(4)(A)(iii)); and 

20 ‘‘(ii) is not enrolled under part C of 

21 such title or under a PACE program under 

22 section 1894; 

23 ‘‘(B) who has been diagnosed with a form 

24 of dementia; 


kjohnson on DSK79L0C42PROD with BILLS
10 

•S 626 IS

1 ‘‘(C) who has not made an election to re2 ceive hospice care; and 

3 ‘‘(D) who is not a resident of a nursing 

4 home. 

5 ‘‘(5) PATIENT PATHWAYS.— 

6 ‘‘(A) INITIAL PLACEMENT.— 

7 ‘‘(i) PLACEMENT OF PATIENTS INTO

8 CARE PATHWAYS.—An eligible entity shall 

9 assign an eligible individual to an appro10 priate pathway (as described in clauses 

11 (ii), (iii), and (iv)) based on an assessment 

12 of the clinical and financial status of the 

13 eligible individual that is conducted not 

14 later than 60 days after the eligible indi15 vidual is enrolled in the model. 

16 ‘‘(ii) PATHWAY FOR UNCOMPLICATED

17 DEMENTIA DIAGNOSIS.—During the pre18 ceding 12-month period, the eligible indi19 vidual has not more than 1 unplanned in20 patient hospitalization or visit to a hospital 

21 emergency department. 

22 ‘‘(iii) PATHWAY FOR DEMENTIA DIAG23 NOSIS WITH ENHANCED CARE COORDINA24 TION NEEDS.—During the preceding 12- 

25 month period, the eligible individual— 


kjohnson on DSK79L0C42PROD with BILLS
11 

•S 626 IS

1 ‘‘(I)(aa) has 2 or more un2 planned inpatient hospitalizations or 

3 visits to a hospital emergency depart4 ment; or 

5 ‘‘(bb) has a psychiatric hos6 pitalization; and 

7 ‘‘(II) has sufficient financial or 

8 caregiver resources (as determined by 

9 the Secretary). 

10 ‘‘(iv) PATHWAY FOR DEMENTIA DIAG11 NOSIS WITH COMPLEX CARE NEEDS.—Dur12 ing the preceding 12-month period, the eli13 gible individual— 

14 ‘‘(I)(aa) has 2 or more un15 planned inpatient hospitalizations or 

16 visits to a hospital emergency depart17 ment; or 

18 ‘‘(bb) has a psychiatric hos19 pitalization; and 

20 ‘‘(II) has insufficient financial or 

21 caregiver resources (as determined by 

22 the Secretary). 

23 ‘‘(B) REGULAR PATIENT ASSESSMENTS

24 FOR APPROPRIATE PATHWAY.— 


kjohnson on DSK79L0C42PROD with BILLS
12 

•S 626 IS

1 ‘‘(i) IN GENERAL.—After determina2 tion of the initial pathway, at a frequency 

3 to be determined by the Secretary, but not 

4 less than once per year, an eligible entity 

5 shall reassess the pathway determination 

6 of each eligible individual enrolled under 

7 the model. 

8 ‘‘(ii) INCREASED ADL LIMITATIONS.— 

9 Each eligible individual enrolled in the 

10 pathway for uncomplicated dementia diag11 nosis (as described in subparagraph 

12 (A)(ii)) who has had increased limitations 

13 in performing activities of daily living since 

14 the prior assessment shall be assigned to 

15 the pathway for dementia diagnosis with 

16 enhanced care coordination needs (as de17 scribed in subparagraph (A)(iii)) or the 

18 pathway for dementia diagnosis with com19 plex care needs (as described in subpara20 graph (A)(iv)), depending on the eligible 

21 individual’s financial and caregiver re22 sources applicable to each pathway. 

23 ‘‘(iii) ENHANCED OR COMPLEX CARE

24 NEEDS.—Each eligible individual enrolled 

25 in the pathway for dementia diagnosis with 


kjohnson on DSK79L0C42PROD with BILLS
13 

•S 626 IS

1 enhanced care coordination needs (as de2 scribed in subparagraph (A)(iii)) or the 

3 pathway for dementia diagnosis with com4 plex care needs (as described in subpara5 graph (A)(iv)) shall be assigned to 1 of the 

6 2 pathways based on the eligible individ7 ual’s financial and caregiver resources ap8 plicable to each pathway. 

9 ‘‘(6) QUALITY ASSESSMENT.— 

10 ‘‘(A) IN GENERAL.—The Secretary shall 

11 specify appropriate measures to assess the qual12 ity of care furnished by an eligible entity under 

13 the Dementia Care Management Model. Such 

14 measures shall include, as appropriate, meas15 ures for clinical processes and outcomes, patient 

16 and caregiver experience of care, and utilization 

17 of services for which payment is made under 

18 the original medicare fee-for-service program 

19 under title XVIII, including measures for— 

20 ‘‘(i) emergency department utilization; 

21 ‘‘(ii) inpatient hospital utilization; 

22 ‘‘(iii) documented advanced care plan; 

23 ‘‘(iv) medication review; 

24 ‘‘(v) screening for future fall risk; 


kjohnson on DSK79L0C42PROD with BILLS
14 

•S 626 IS

1 ‘‘(vi) depression screening for care2 givers; 

3 ‘‘(vii) caregiver stress assessment; and 

4 ‘‘(viii) caregiver assessment of out5 comes. 

6 ‘‘(B) REPORTING.—An eligible entity shall 

7 submit data in a form and manner determined 

8 by the Secretary on measures specified by the 

9 Secretary. 

10 ‘‘(C) PERFORMANCE ASSESSMENT.—In 

11 order to assess the quality of care furnished by 

12 an eligible entity under the model, the Sec13 retary shall establish— 

14 ‘‘(i) quality performance standards; 

15 and 

16 ‘‘(ii) methodologies for quality per17 formance scoring and related payment ad18 justments. 

19 ‘‘(D) STAKEHOLDER INPUT.—The Sec20 retary shall seek input from eligible entities on 

21 final measure specifications, including appro22 priate adjustment for patient preferences. 

23 ‘‘(7) PAYMENTS.— 

24 ‘‘(A) IN GENERAL.—Under the Dementia 

25 Care Management Model, the Secretary shall 


kjohnson on DSK79L0C42PROD with BILLS
15 

•S 626 IS

1 establish payment amounts for care manage2 ment services furnished to eligible individuals, 

3 including initial investment costs. Such 

4 amounts shall reflect start-up costs and initial 

5 investments incurred by an eligible entity in es6 tablishing the Dementia Care Management 

7 Model. 

8 ‘‘(B) CAPITATED BASIS.—Payments under 

9 the Dementia Care Management Model shall be 

10 made on a capitated basis, such as a per-mem11 ber, per-month payment, or such other similar 

12 payment mechanisms that the Secretary deter13 mines to be appropriate. Payments shall vary 

14 based on the assigned pathway of each patient 

15 as described in paragraph (5). 

16 ‘‘(C) QUALITY BONUS.—Under the Demen17 tia Care Management Model, additional pay18 ments shall be made to any eligible entity for 

19 quality bonuses based on the performance of 

20 the eligible entity in providing quality care (as 

21 determined under paragraph (6)). 

22 ‘‘(D) ZERO COST-SHARING.—An eligible in23 dividual shall not be liable for any cost-sharing, 

24 including deductibles, coinsurance, or copay25 ments, for care management services for deVerDate Sep 11 2014 00:15 Mar 15, 2023 Jkt 039200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\S626.IS S626

kjohnson on DSK79L0C42PROD with BILLS
16 

•S 626 IS

1 mentia care furnished to such eligible individual 

2 under the model. 

3 ‘‘(E) SUPPLEMENTAL TO PAYMENTS FOR

4 COVERED SERVICES.—Payments made under 

5 the model shall be in addition to any payments 

6 for items or services not provided under the 

7 model for which payment may be made under 

8 title XVIII for services furnished to such eligi9 ble individuals. 

10 ‘‘(F) NONDUPLICATION.—Payments for 

11 care management services furnished to eligible 

12 individuals under the Dementia Care Manage13 ment Model may not duplicate payments for 

14 services furnished to such eligible individuals 

15 for which payments are made under the original 

16 medicare fee-for-service program under title 

17 XVIII. 

18 ‘‘(8) WAIVERS.—The Secretary shall waive pro19 visions of this title, and title XVIII, to permit an eli20 gible entity operating a Dementia Care Management 

21 Model to provide the following: 

22 ‘‘(A) BENEFICIARY REWARDS.—Gift cards 

23 or other rewards for patients who successfully 

24 participate in the program (as determined by 

25 the Secretary). 


kjohnson on DSK79L0C42PROD with BILLS
17 

•S 626 IS

1 ‘‘(B) CAREGIVERS.—Supports for care2 givers. 

3 ‘‘(C) TELEHEALTH.—Telehealth services 

4 without regard to geographic or other origi5 nating site limitations under section 1834(m). 

6 ‘‘(D) SERVICES FROM COMMUNITY ORGA7 NIZATIONS.—Payments, cost-sharing support, 

8 or both, for nonmedical services furnished by 

9 community-based organizations, such as limited 

10 caregiving services, respite care, adult day care 

11 counseling services, and such other services as 

12 the Secretary determines to be appropriate. 

13 ‘‘(9) MODIFICATIONS FOR APPLICATION IN THE

14 PRIMARY CARE FIRST AND DIRECT CONTRACTING

15 MODELS.— 

16 ‘‘(A) IN GENERAL.—Except as provided 

17 under subparagraph (B), if the Secretary elects 

18 to incorporate the Dementia Care Management 

19 Model into the Primary Care First Model, the 

20 Direct Contracting Model, or both, as provided 

21 for under paragraph (1)(C)(i), the Secretary 

22 shall maintain the requirements of this sub23 section. 

24 ‘‘(B) PERMISSIBLE MODIFICATIONS.—The 

25 Secretary may adjust the requirements of this 


kjohnson on DSK79L0C42PROD with BILLS
18 

•S 626 IS

1 subsection to the extent necessary to ensure 

2 consistency of the Dementia Care Management 

3 Model with the Primary Care First Model, the 

4 Direct Contracting Model, or both, with respect 

5 to— 

6 ‘‘(i) any eligible entity, including bene7 ficiary alignment thresholds; 

8 ‘‘(ii) any eligible individual; 

9 ‘‘(iii) capitated payments; and 

10 ‘‘(iv) quality-bonus payments. 

11 ‘‘(C) CONSULTATION WITH STAKE12 HOLDERS.—Prior to making any adjustment 

13 under subparagraph (B), the Secretary shall 

14 consult with appropriate stakeholders and pa15 tient advocacy organizations. 

16 ‘‘(10) OUTREACH TO UNDERREPRESENTED MI17 NORITY POPULATIONS.—An eligible entity shall 

18 carry out public outreach and education efforts, in19 cluding the dissemination of information, for mem20 bers of underrepresented minority populations re21 garding participation in the Dementia Care Manage22 ment Model to ensure diversity in the patient popu23 lation of such model. 

24 ‘‘(11) OPTION TO EXPAND TO MEDICAID.—The 

25 Secretary may design a model under which payVerDate Sep 11 2014 00:15 Mar 15, 2023 Jkt 039200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\S626.IS S626

kjohnson on DSK79L0C42PROD with BILLS
19 

•S 626 IS

1 ments are made under title XIX, in a similar man2 ner to the manner in which payments are made 

3 under title XVIII under the Dementia Care Manage4 ment Model described in this subsection, to eligible 

5 entities that furnish comprehensive care manage6 ment services to individuals who are eligible for med7 ical assistance under a State plan under title XIX 

8 (or a waiver of such a plan) with Alzheimer’s disease 

9 or a related dementia, in order to test the effective10 ness of comprehensive care management services on 

11 patient health, care quality, and care experience, as 

12 well as on unpaid caregivers, and on reducing spend13 ing under title XIX without reducing the quality of 

14 care.’’. 

Æ 


kjohnson on DSK79L0C42PROD with BILLS