I 

117TH CONGRESS 

1ST SESSION H. R. 2517 

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 HOUSE OF REPRESENTATIVES 

APRIL 14, 2021 

Mr. HIGGINS of New York (for himself, Mr. LAHOOD, Mr. TONKO, and Mr. 

GUTHRIE) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on 

Ways and Means, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

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— 


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

2 end the following new clause: 

3 ‘‘(xxviii) Furnishing comprehensive 

4 care management services to eligible indi5 viduals with Alzheimer’s disease or a re6 lated dementia through a Dementia Care 

7 Management Model, as described in sub8 section (h).’’; and 

9 (2) by adding at the end the following new sub10 section: 

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

12 ‘‘(1) DESCRIPTION OF MODEL AND REQUIRE13 MENTS.— 

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

15 Management Model described in this subsection 

16 is a model under which payments are made 

17 under title XVIII to eligible entities that fur18 nish comprehensive care management services 

19 to eligible individuals with Alzheimer’s disease 

20 or a related dementia, in order to test the effec21 tiveness of comprehensive care management 

22 services on patient health, care quality, and 

23 care experience, as well as on unpaid caregivers, 

24 and on reducing spending under title XVIII 

25 without reducing the quality of care. 


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1 ‘‘(B) VOLUNTARY PARTICIPATION.—Par2 ticipation under the Dementia Care Manage3 ment Model shall be voluntary with respect to 

4 both eligible individuals and eligible entities. 

5 ‘‘(C) IMPLEMENTATION OF DEMENTIA

6 CARE MANAGEMENT MODEL.— 

7 ‘‘(i) IN GENERAL.—The Secretary 

8 shall— 

9 ‘‘(I) implement the Dementia 

10 Care Management Model as a stand11 alone model; 

12 ‘‘(II) incorporate the Dementia 

13 Care Management Model into the Pri14 mary Care First Model; or 

15 ‘‘(III) incorporate the Dementia 

16 Care Management Model into— 

17 ‘‘(aa) the Primary Care 

18 First Model; and 

19 ‘‘(bb) the Direct Contracting 

20 Model. 

21 ‘‘(ii) ADDITIONAL AUTHORITY.—In 

22 addition to the models described in sub23 clauses (I) through (III) of clause (i), the 

24 Secretary may incorporate the Dementia 

25 Care Management Model into other existVerDate Sep 11 2014 02:39 Jun 04, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2517.IH H2517

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1 ing coordinated care models established 

2 under title XVIII or under this section, in3 cluding accountable care organizations, 

4 value-based purchasing arrangements, and 

5 such other coordinated care models as the 

6 Secretary determines to be appropriate. 

7 ‘‘(2) COMPREHENSIVE CARE MANAGEMENT

8 SERVICES DEFINED.—In this subsection, the term 

9 ‘comprehensive care management services’ means 

10 the following services furnished by an eligible entity 

11 with respect to an eligible individual: 

12 ‘‘(A) CONTINUOUS MONITORING AND AS13 SESSMENT.—An eligible entity shall regularly 

14 assess and continuously monitor the following: 

15 ‘‘(i) Neuropsychiatric symptoms, in16 cluding behavior, physical safety, and func17 tion of an eligible individual. 

18 ‘‘(ii) Comorbidities. 

19 ‘‘(iii) Financial resources and needs. 

20 ‘‘(iv) Caregiver supports and re21 sources, including caregiver education, 

22 training, and support. 

23 ‘‘(v) The well-being of unpaid care24 givers of the eligible individual. 


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

2 eligible individual’s home and environment 

3 and the need for support for activities of 

4 daily living. 

5 ‘‘(B) ONGOING DEMENTIA CARE PLAN.— 

6 An eligible entity shall develop and implement 

7 an Alzheimer’s disease or related dementia care 

8 plan, including advance care planning as appro9 priate, for an eligible individual. The care plan 

10 shall include patient-centered goals for the eligi11 ble individual as well as goals for unpaid care12 givers of the eligible individual. Such care plan 

13 shall be continuously evaluated and modified as 

14 appropriate. 

15 ‘‘(C) PSYCHOSOCIAL INTERVENTIONS.—An 

16 eligible entity may implement psychosocial 

17 interventions designed to prevent or reduce the 

18 burden of cognitive, functional, behavioral, and 

19 psychological challenges as well as the associ20 ated stress on unpaid caregivers of the eligible 

21 individual. 

22 ‘‘(D) SELF-MANAGEMENT TOOLS.—An eli23 gible entity shall provide self-management tools 

24 to enhance the skills of the unpaid caregiver of 

25 the eligible individual to manage the AlzVerDate Sep 11 2014 02:39 Jun 04, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2517.IH H2517

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1 heimer’s disease or related dementia of the eli2 gible individual and to navigate the health care 

3 system. Such tools shall include training and 

4 support for unpaid caregivers in managing the 

5 limitations of eligible individuals, including edu6 cation, problem solving strategies, care naviga7 tion support, support after discharge from a 

8 hospital or nursing home, and decision-making 

9 support. 

10 ‘‘(E) MEDICATION MANAGEMENT.—An eli11 gible entity shall furnish evidence-based medica12 tion review and management services to an eli13 gible individual, including polypharmacy man14 agement, using a planned process to reduce or 

15 stop medications that may no longer be of ben16 efit or may be having adverse cognitive effects, 

17 prescribing approved medications, and enhanc18 ing adherence to appropriate medications. 

19 ‘‘(F) TREATMENT OF RELATED CONDI20 TIONS.—An eligible entity shall provide inter21 ventions to prevent or treat conditions related 

22 to the Alzheimer’s disease or related dementia 

23 of the eligible individual, such as depression 

24 and delirium. 


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

2 entity shall provide ongoing care management 

3 services and shall coordinate services and sup4 ports among providers of services and suppliers, 

5 as well as social and community resources. 

6 Such services shall include necessary assistance 

7 for referrals to social and community-based or8 ganizations, collaboration with primary care 

9 providers and the interdisciplinary team of the 

10 eligible individual, and support for care transi11 tions and continuity of care. 

12 ‘‘(H) EXCLUSION OF PALLIATIVE CARE

13 AND HOSPICE CARE.—Comprehensive care man14 agement services shall not include palliative 

15 care or hospice care. 

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

17 may require or permit other services, as appro18 priate. 

19 ‘‘(3) ELIGIBLE ENTITY DEFINED.—In this sub20 section, the term ‘eligible entity’ means an entity, 

21 such as a health system, hospital, physician or non22 physician group practice, multiple physician prac23 tices, a Federally qualified health center, a rural 

24 health clinic, or an accountable care organization, 

25 that— 


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1 ‘‘(A) is qualified to furnish comprehensive 

2 care management services to an eligible indi3 vidual, and any unpaid caregiver of such eligible 

4 individual, under the Dementia Care Manage5 ment Model either directly or through arrange6 ments with Medicare participating providers of 

7 services and suppliers as well as social and com8 munity-based organizations; 

9 ‘‘(B) is accountable for the quality of com10 prehensive care management services furnished 

11 to an eligible individual under the model; 

12 ‘‘(C) furnishes comprehensive care man13 agement services through an interdisciplinary 

14 team that has at least 1 physician, physician 

15 assistant, nurse practitioner, or advanced prac16 tice nurse who devotes 25 percent or more of 

17 patient contact time to the evaluation and care 

18 of patients with acquired cognitive impairment; 

19 ‘‘(D) furnishes comprehensive care man20 agement services in a culturally appropriate 

21 manner; 

22 ‘‘(E) utilizes a comprehensive, person-cen23 tered care management approach; 


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1 ‘‘(F) furnishes wellness and healthcare 

2 planning, including medication review and man3 agement; 

4 ‘‘(G) supports family and caregiver engage5 ment; 

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

7 provider or a member of the interdisciplinary 

8 team 24 hours a day 7 days a week; 

9 ‘‘(I) has relationships with medical and 

10 nonmedical community-based organizations that 

11 support patients with Alzheimer’s disease or a 

12 related dementia and their caregivers; and 

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

14 Secretary may determine to be appropriate. 

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

16 subsection, the term ‘eligible individual’ means an 

17 individual— 

18 ‘‘(A) who— 

19 ‘‘(i) is entitled to, or enrolled for, ben20 efits under part A of title XVIII and en21 rolled under part B of such title (including 

22 such an individual who is a dual eligible in23 dividual described in subsection 

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


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

2 such title or under a PACE program under 

3 section 1894; 

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

5 of dementia; 

6 ‘‘(C) who has not made an election to re7 ceive hospice care; and 

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

9 home. 

10 ‘‘(5) PATIENT PATHWAYS.— 

11 ‘‘(A) INITIAL PLACEMENT.— 

12 ‘‘(i) PLACEMENT OF PATIENTS INTO

13 CARE PATHWAYS.—An eligible entity shall 

14 assign an eligible individual to an appro15 priate pathway (as described in clauses 

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

17 of the clinical and financial status of the 

18 eligible individual that is conducted not 

19 later than 60 days after the eligible indi20 vidual is enrolled in the model. 

21 ‘‘(ii) PATHWAY FOR UNCOMPLICATED

22 DEMENTIA DIAGNOSIS.—During the pre23 ceding 12-month period, the eligible indi24 vidual has not more than 1 unplanned inVerDate Sep 11 2014 02:39 Jun 04, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2517.IH H2517

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1 patient hospitalization or visit to a hospital 

2 emergency department. 

3 ‘‘(iii) PATHWAY FOR DEMENTIA DIAG4 NOSIS WITH ENHANCED CARE COORDINA5 TION NEEDS.—During the preceding 12- 

6 month period, the eligible individual— 

7 ‘‘(I)(aa) has 2 or more un8 planned inpatient hospitalizations or 

9 visits to a hospital emergency depart10 ment; or 

11 ‘‘(bb) has a psychiatric hos12 pitalization; and 

13 ‘‘(II) has sufficient financial or 

14 caregiver resources (as determined by 

15 the Secretary). 

16 ‘‘(iv) PATHWAY FOR DEMENTIA DIAG17 NOSIS WITH COMPLEX CARE NEEDS.—Dur18 ing the preceding 12-month period, the eli19 gible individual— 

20 ‘‘(I)(aa) has 2 or more un21 planned inpatient hospitalizations or 

22 visits to a hospital emergency depart23 ment; or 

24 ‘‘(bb) has a psychiatric hos25 pitalization; and 


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1 ‘‘(II) has insufficient financial or 

2 caregiver resources (as determined by 

3 the Secretary). 

4 ‘‘(B) REGULAR PATIENT ASSESSMENTS

5 FOR APPROPRIATE PATHWAY.— 

6 ‘‘(i) IN GENERAL.—After determina7 tion of the initial pathway, at a frequency 

8 to be determined by the Secretary, but not 

9 less than once per year, an eligible entity 

10 shall reassess the pathway determination 

11 of each eligible individual enrolled under 

12 the model. 

13 ‘‘(ii) INCREASED ADL LIMITATIONS.— 

14 Each eligible individual enrolled in the 

15 pathway for uncomplicated dementia diag16 nosis (as described in subparagraph 

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

18 in performing activities of daily living since 

19 the prior assessment shall be assigned to 

20 the pathway for dementia diagnosis with 

21 enhanced care coordination needs (as de22 scribed in subparagraph (A)(iii)) or the 

23 pathway for dementia diagnosis with com24 plex care needs (as described in subpara25 graph (A)(iv)), depending on the eligible 


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1 individual’s financial and caregiver re2 sources applicable to each pathway. 

3 ‘‘(iii) ENHANCED OR COMPLEX CARE

4 NEEDS.—Each eligible individual enrolled 

5 in the pathway for dementia diagnosis with 

6 enhanced care coordination needs (as de7 scribed in subparagraph (A)(iii)) or the 

8 pathway for dementia diagnosis with com9 plex care needs (as described in subpara10 graph (A)(iv)) shall be assigned to 1 of the 

11 2 pathways based on the eligible individ12 ual’s financial and caregiver resources ap13 plicable to each pathway. 

14 ‘‘(6) QUALITY ASSESSMENT.— 

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

16 specify appropriate measures to assess the qual17 ity of care furnished by an eligible entity under 

18 the Dementia Care Management Model. Such 

19 measures shall include, as appropriate, meas20 ures for clinical processes and outcomes, patient 

21 and caregiver experience of care, and utilization 

22 of services for which payment is made under 

23 the original medicare fee-for-service program 

24 under title XVIII, including measures for— 

25 ‘‘(i) emergency department utilization; 


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1 ‘‘(ii) inpatient hospital utilization; 

2 ‘‘(iii) documented advanced care plan; 

3 ‘‘(iv) medication review; 

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

5 ‘‘(vi) depression screening for care6 givers; 

7 ‘‘(vii) caregiver stress assessment; and 

8 ‘‘(viii) caregiver assessment of out9 comes. 

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

11 submit data in a form and manner determined 

12 by the Secretary on measures specified by the 

13 Secretary. 

14 ‘‘(C) PERFORMANCE ASSESSMENT.—In 

15 order to assess the quality of care furnished by 

16 an eligible entity under the model, the Sec17 retary shall establish— 

18 ‘‘(i) quality performance standards; 

19 and 

20 ‘‘(ii) methodologies for quality per21 formance scoring and related payment ad22 justments. 

23 ‘‘(D) STAKEHOLDER INPUT.—The Sec24 retary shall seek input from eligible entities on 


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1 final measure specifications, including appro2 priate adjustment for patient preferences. 

3 ‘‘(7) PAYMENTS.— 

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

5 Care Management Model, the Secretary shall 

6 establish payment amounts for care manage7 ment services furnished to eligible individuals, 

8 including initial investment costs. Such 

9 amounts shall reflect start-up costs and initial 

10 investments incurred by an eligible entity in es11 tablishing the Dementia Care Management 

12 Model. 

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

14 the Dementia Care Management Model shall be 

15 made on a capitated basis, such as a per-mem16 ber, per-month payment, or such other similar 

17 payment mechanisms that the Secretary deter18 mines to be appropriate. Payments shall vary 

19 based on the assigned pathway of each patient 

20 as described in paragraph (5). 

21 ‘‘(C) QUALITY BONUS.—Under the Demen22 tia Care Management Model, additional pay23 ments shall be made to any eligible entity for 

24 quality bonuses based on the performance of 


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1 the eligible entity in providing quality care (as 

2 determined under paragraph (6)). 

3 ‘‘(D) ZERO COST-SHARING.—An eligible in4 dividual shall not be liable for any cost-sharing, 

5 including deductibles, coinsurance, or copay6 ments, for care management services for de7 mentia care furnished to such eligible individual 

8 under the model. 

9 ‘‘(E) SUPPLEMENTAL TO PAYMENTS FOR

10 COVERED SERVICES.—Payments made under 

11 the model shall be in addition to any payments 

12 for items or services not provided under the 

13 model for which payment may be made under 

14 title XVIII for services furnished to such eligi15 ble individuals. 

16 ‘‘(F) NONDUPLICATION.—Payments for 

17 care management services furnished to eligible 

18 individuals under the Dementia Care Manage19 ment Model may not duplicate payments for 

20 services furnished to such eligible individuals 

21 for which payments are made under the original 

22 medicare fee-for-service program under title 

23 XVIII. 

24 ‘‘(8) WAIVERS.—The Secretary shall waive pro25 visions of this title, and title XVIII, to permit an eliVerDate Sep 11 2014 02:39 Jun 04, 2021 Jkt 019200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H2517.IH H2517

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1 gible entity operating a Dementia Care Management 

2 Model to provide the following: 

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

4 or other rewards for patients who successfully 

5 participate in the program (as determined by 

6 the Secretary). 

7 ‘‘(B) CAREGIVERS.—Supports for care8 givers. 

9 ‘‘(C) TELEHEALTH.—Telehealth services 

10 without regard to geographic or other origi11 nating site limitations under section 1834(m). 

12 ‘‘(D) SERVICES FROM COMMUNITY ORGA13 NIZATIONS.—Payments, cost-sharing support, 

14 or both, for nonmedical services furnished by 

15 community-based organizations, such as limited 

16 caregiving services, respite care, adult day care 

17 counseling services, and such other services as 

18 the Secretary determines to be appropriate. 

19 ‘‘(9) MODIFICATIONS FOR APPLICATION IN THE

20 PRIMARY CARE FIRST AND DIRECT CONTRACTING

21 MODELS.— 

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

23 under subparagraph (B), if the Secretary elects 

24 to incorporate the Dementia Care Management 

25 Model into the Primary Care First Model, the 


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1 Direct Contracting Model, or both, as provided 

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

3 shall maintain the requirements of this sub4 section. 

5 ‘‘(B) PERMISSIBLE MODIFICATIONS.—The 

6 Secretary may adjust the requirements of this 

7 subsection to the extent necessary to ensure 

8 consistency of the Dementia Care Management 

9 Model with the Primary Care First Model, the 

10 Direct Contracting Model, or both, with respect 

11 to— 

12 ‘‘(i) any eligible entity, including bene13 ficiary alignment thresholds; 

14 ‘‘(ii) any eligible individual; 

15 ‘‘(iii) capitated payments; and 

16 ‘‘(iv) quality-bonus payments. 

17 ‘‘(C) CONSULTATION WITH STAKE18 HOLDERS.—Prior to making any adjustment 

19 under subparagraph (B), the Secretary shall 

20 consult with appropriate stakeholders and pa21 tient advocacy organizations. 

22 ‘‘(10) OUTREACH TO UNDERREPRESENTED MI23 NORITY POPULATIONS.—An eligible entity shall 

24 carry out public outreach and education efforts, in25 cluding the dissemination of information, for memVerDate Sep 11 2014 02:39 Jun 04, 2021 Jkt 019200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\H2517.IH H2517

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1 bers of underrepresented minority populations re2 garding participation in the Dementia Care Manage3 ment Model to ensure diversity in the patient popu4 lation of such model. 

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

6 Secretary may design a model under which pay7 ments are made under title XIX, in a similar man8 ner to the manner in which payments are made 

9 under title XVIII under the Dementia Care Manage10 ment Model described in this subsection, to eligible 

11 entities that furnish comprehensive care manage12 ment services to individuals who are eligible for med13 ical assistance under a State plan under title XIX 

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

15 or a related dementia, in order to test the effective16 ness of comprehensive care management services on 

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

18 well as on unpaid caregivers, and on reducing spend19 ing under title XIX without reducing the quality of 

20 care.’’. 

Æ 


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