I 

112TH CONGRESS 

1ST SESSION H. R. 1386 

To amend title XVIII of the Social Security Act to provide for Medicare 

coverage of comprehensive Alzheimer’s disease and related dementia diagnosis and services in order to improve care and outcomes for Americans 

living with Alzheimer’s disease and related dementias by improving detection, diagnosis, and care planning. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 6, 2011 

Mr. MARKEY (for himself, Mr. SMITH of New Jersey, Ms. BORDALLO, Mr. 

BURGESS, Mrs. CHRISTENSEN, Mr. GRIJALVA, Mr. MCDERMOTT, and 

Mr. PIERLUISI) 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 amend title XVIII of the Social Security Act to provide 

for Medicare coverage of comprehensive Alzheimer’s disease and related dementia diagnosis and services in order 

to improve care and outcomes for Americans living with 

Alzheimer’s disease and related dementias by improving 

detection, diagnosis, and care planning. 

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


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Health Outcomes, 

3 Planning, and Education for Alzheimer’s Act’’. 

4 SEC. 2. MEDICARE COVERAGE OF COMPREHENSIVE ALZ5 HEIMER’S DISEASE DIAGNOSIS AND SERV6 ICES. 

7 (a) IN GENERAL.—Section 1861 of the Social Secu8 rity Act is amended— 

9 (1) in subsection (s)(2)— 

10 (A) by striking ‘‘and’’ at the end of sub11 paragraph (EE); 

12 (B) by adding ‘‘and’’ at the end of sub13 paragraph (FF); and 

14 (C) by adding at the end the following new 

15 subparagraph: 

16 ‘‘(GG) comprehensive Alzheimer’s disease diag17 nosis and services (as defined in subsection (iii));’’; 

18 and 

19 (2) by adding at the end the following new sub20 section: 

21 ‘‘Comprehensive Alzheimer’s Disease Diagnosis and 

22 Services 

23 ‘‘(iii)(1) The term ‘comprehensive Alzheimer’s disease 

24 diagnosis and services’ means the services described in 

25 paragraph (2) furnished to an individual— 


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1 ‘‘(A) who does not already have a diagnosis of 

2 Alzheimer’s disease; and 

3 ‘‘(B) for whom a physician or a practitioner de4 scribed in clause (i), (iv), or (v) of section 

5 1842(b)(18)(C), in a medical setting such as a phy6 sician’s office, a hospital, a skilled nursing facility, 

7 a community health center, or another similar med8 ical setting— 

9 ‘‘(i) has detected the individual may have 

10 a cognitive impairment or dementia; and 

11 ‘‘(ii) pursuant to such detection, has deter12 mined a diagnostic evaluation for Alzheimer’s 

13 disease is needed. 

14 ‘‘(2) The services described in this paragraph are the 

15 following: 

16 ‘‘(A) A diagnostic evaluation, including referral 

17 to a specialist if recommended. 

18 ‘‘(B) If the individual is diagnosed with Alz19 heimer’s disease under the diagnostic evaluation 

20 under subparagraph (A), care planning services 

21 (with the individual or with one or more family care22 givers of the individual without the presence of the 

23 individual), including assistance understanding the 

24 diagnosis as well as the medical and non-medical op25 tions for ongoing treatment, services, and supports, 


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1 and information about how to obtain such treat2 ments, services, and supports. 

3 ‘‘(C) Medical record documentation, with re4 spect to an individual, of the diagnostic evaluation 

5 under subparagraph (A), the diagnosis, and any care 

6 planning services under subparagraph (B). 

7 ‘‘(3) In this subsection, the term ‘Alzheimer’s disease’ 

8 means Alzheimer’s disease and related dementias.’’. 

9 (b) PAYMENT.—Section 1833(a)(1) of the Social Se10 curity Act (42 U.S.C. 1395l(a)(1)) is amended by striking 

11 ‘‘and’’ before ‘‘(Z)’’ and inserting before the semicolon at 

12 the end the following: ‘‘, and (AA) with respect to com13 prehensive Alzheimer’s disease diagnosis and services (as 

14 defined in section 1861(iii)), the amount paid shall be an 

15 amount equal to 80 percent of the amount determined 

16 under a fee schedule designated by the Secretary’’. 

17 (c) EFFECTIVE DATE.—The amendments made by 

18 this section shall apply to services furnished on or after 

19 January 1 of the year following the year which includes 

20 the date of the enactment of this Act. 

Æ 


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