II 

Calendar No. 694 

115TH CONGRESS 

2D SESSION S. 2076 

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. 

IN THE SENATE OF THE UNITED STATES 

NOVEMBER 6, 2017 

Ms. COLLINS (for herself, Ms. CORTEZ MASTO, Mrs. CAPITO, Mr. KAINE, Mr. 

COONS, Mr. WICKER, Mr. MARKEY, Ms. STABENOW, Mr. KING, Ms. 

WARREN, Mr. CRAPO, Mr. YOUNG, Mr. RISCH, Mr. VAN HOLLEN, Mr. 

MORAN, Mr. BLUMENTHAL, Mr. INHOFE, Mr. BOOZMAN, Mr. ROUNDS, 

Mr. SANDERS, Mr. BARRASSO, Mrs. SHAHEEN, Mr. GARDNER, Ms. 

HEITKAMP, Mr. CASEY, Mr. KENNEDY, Ms. KLOBUCHAR, Mr. NELSON, 

Mr. MURPHY, Mr. CASSIDY, Mr. TILLIS, Ms. HASSAN, Ms. SMITH, Mrs. 

FISCHER, Ms. MURKOWSKI, Ms. HIRONO, Mr. DONNELLY, Mrs. GILLIBRAND, Mr. BENNET, Mr. JONES, Ms. BALDWIN, Mr. MERKLEY, Mr. 

WHITEHOUSE, Mr. PETERS, Mrs. HYDE-SMITH, Mr. TESTER, Mr. 

MENENDEZ, Mrs. FEINSTEIN, Mr. SULLIVAN, Mr. WYDEN, Mr. ROBERTS, Mr. HEINRICH, Mr. REED, Mr. BOOKER, Mr. BROWN, and Ms. 

HARRIS) introduced the following bill; which was read twice and referred 

to the Committee on Health, Education, Labor, and Pensions 

NOVEMBER 29, 2018 

Reported by Mr. ALEXANDER, with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

A BILL 

To amend the Public Health Service Act to authorize the 

expansion of activities related to Alzheimer’s disease, cogVerDate Sep 11 2014 23:58 Nov 29, 2018 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\S2076.RS S2076

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nitive decline, and brain health under the Alzheimer’s 

Disease and Healthy Aging Program, 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 ‘‘Building Our Largest 

5 Dementia Infrastructure for Alzheimer’s Act’’ or the 

6 ‘‘BOLD Infrastructure for Alzheimer’s Act’’. 

7 SEC. 2. FINDINGS. 

8 Congress finds as follows: 

9 (1) According to former Surgeon General and 

10 Director of the Centers for Disease Control and Pre11 vention, Dr. David Satcher, ‘‘Alzheimer’s is the most 

12 under-recognized threat to public health in the 21st 

13 century.’’. 

14 (2) Deaths from Alzheimer’s disease increased 

15 55 percent between 1999 and 2014 in the United 

16 States, according to data from the Centers for Dis17 ease Control and Prevention. 

18 (3) More than 5,000,000 people in the United 

19 States are living with Alzheimer’s disease and, with20 out significant efforts to change the current trajec21 tory, as many as 16,000,000 people in the United 

22 States will have Alzheimer’s disease by 2050. This 

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1 heimer’s disease to increase from an estimated 

2 $259,000,000,000 in 2017 to more than 

3 $1,100,000,000,000 in 2050 (in 2017 dollars). 

4 (4) Among individuals living with Alzheimer’s 

5 disease and other dementias, evidence indicates as 

6 many as 50 percent have not been diagnosed. 

7 Among individuals diagnosed with Alzheimer’s dis8 ease, only 33 percent are aware of the diagnosis. 

9 Early detection and diagnosis of Alzheimer’s disease 

10 and other dementias allow people to access available 

11 treatments, build a care team, participate in support 

12 services, and enroll in clinical trials. Early detection 

13 can help physicians better manage a patient’s co14 morbid conditions and avoid prescribing medications 

15 that may worsen cognition or function. 

16 (5) Among individuals living with Alzheimer’s 

17 disease and other dementias, 25.3 percent experience 

18 a preventable hospitalization, and such preventable 

19 hospitalizations cost the Medicare program nearly 

20 $2,600,000,000 in 2013. 

21 (6) African Americans are about 2 times more 

22 likely than White Americans to have Alzheimer’s dis23 ease and other dementias. Hispanics are about one 

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1 cans to have Alzheimer’s disease and other demen2 tias. 

3 (7) In 2016, 15,900,000 family members and 

4 friends provided 18,200,000,000 hours of unpaid 

5 care to individuals with Alzheimer’s disease and 

6 other dementias, at an economic value of over 

7 $230,000,000,000. The physical and emotional im8 pact of caregiving of individuals with Alzheimer’s 

9 disease and other dementia resulted in an estimated 

10 $10,900,000,000 in increased caregiver health costs 

11 in 2016. 

12 (8) Strategy 4.B of the ‘‘National Plan to Ad13 dress Alzheimer’s Disease: 2017 Update’’ of the Of14 fice of the Assistant Secretary for Planning and 

15 Evaluation of the Department of Health and Human 

16 Services is to ‘‘work with State, Tribal, and local 

17 governments to improve coordination and identify 

18 model initiatives to advance Alzheimer’s disease 

19 awareness and readiness across the Government.’’. 


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1 SEC. 3. PROMOTION OF PUBLIC HEALTH KNOWLEDGE AND 

2 AWARENESS OF ALZHEIMER’S DISEASE, COG3 NITIVE DECLINE, AND BRAIN HEALTH UNDER 

4 THE ALZHEIMER’S DISEASE AND HEALTHY 

5 AGING PROGRAM. 

6 Part P of title III of the Public Health Service Act 

7 (42 U.S.C. 280g et seq.) is amended by adding at the end 

8 the following: 

9 ‘‘SEC. 399V–7. PROMOTION OF PUBLIC HEALTH KNOWL10 EDGE AND AWARENESS OF ALZHEIMER’S DIS11 EASE, COGNITIVE DECLINE, AND BRAIN 

12 HEALTH UNDER THE ALZHEIMER’S DISEASE 

13 AND HEALTHY AGING PROGRAM. 

14 ‘‘(a) DEFINITIONS.—In the section: 

15 ‘‘(1) ALZHEIMER’S DISEASE.—The term ‘Alz16 heimer’s disease’ means Alzheimer’s disease and re17 lated dementias. 

18 ‘‘(2) INDIAN TRIBE; TRIBAL ORGANIZATION.— 

19 The terms ‘Indian tribe’ and ‘tribal organization’ 

20 have the meanings given such terms in section 4 of 

21 the Indian Health Care Improvement Act. 

22 ‘‘(b) EXPANSION OF ACTIVITIES UNDER THE ALZ23 HEIMER’S DISEASE AND HEALTHY AGING PROGRAM.—In 

24 addition to activities conducted by the Secretary under the 

25 Alzheimer’s Disease and Healthy Aging Program of the 

26 Centers for Disease Control and Prevention, the SecVerDate Sep 11 2014 23:58 Nov 29, 2018 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6401 E:\BILLS\S2076.RS S2076

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1 retary, acting through the Director of the Centers for Dis2 ease Control and Prevention, subject to appropriations 

3 under subsection (g), shall award cooperative agreements 

4 under subsections (c), (d), and (e). 

5 ‘‘(c) CENTERS OF EXCELLENCE IN PUBLIC HEALTH

6 PRACTICE.— 

7 ‘‘(1) IN GENERAL.—The Secretary shall award 

8 cooperative agreements to eligible entities for the es9 tablishment or support of national or regional cen10 ters of excellence in public health practice in Alz11 heimer’s disease to— 

12 ‘‘(A) advance the education of public 

13 health officials of States, of political subdivi14 sions of States, and of Indian tribes or tribal 

15 organizations, health care professionals, and the 

16 public on Alzheimer’s disease, cognitive decline, 

17 brain health, and associated health disparities; 

18 ‘‘(B) advance the efforts of public health 

19 officials referred to in subparagraph (A) in ap20 plying evidence-based systems change, commu21 nications, and programmatic interventions for 

22 populations with cognitive impairment, includ23 ing Alzheimer’s disease, and caregivers for such 

24 populations; and 


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1 ‘‘(C) expand public-private partnerships 

2 engaged in activities related to cognitive impair3 ment and associated health disparities with 

4 demonstrated success or innovative programs 

5 (as determined by the Secretary). 

6 ‘‘(2) REQUIREMENTS.—To be eligible to receive 

7 a cooperative agreement under this subsection, an 

8 entity shall submit to the Secretary an application 

9 containing such agreements and information as the 

10 Secretary may require, including an agreement that 

11 the center to be established or supported under the 

12 cooperative agreement will operate in accordance 

13 with the following: 

14 ‘‘(A) The center will examine, evaluate, in15 crease, and promote evidence-based and effec16 tive Alzheimer’s disease and caregiving-related 

17 interventions for health and social services pro18 fessionals, underserved populations, families, 

19 and the public, after consultation with relevant 

20 State and local public health officials, private21 sector Alzheimer’s disease researchers, and ad22 vocates for individuals with Alzheimer’s disease. 

23 ‘‘(B) The center will prioritize its activities 

24 on the following: 


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1 ‘‘(i) Expanding efforts to educate 

2 State, local, and tribal officials and public 

3 health professionals in applying established 

4 data and evidence-based best practices to 

5 address Alzheimer’s disease. 

6 ‘‘(ii) Supporting public health officials 

7 of States, of political subdivisions of 

8 States, and of Indian tribes or tribal orga9 nizations in implementing the most current 

10 version of the ‘Healthy Brain Initiative: 

11 Public Health Road Map’ of the Centers 

12 for Disease Control and Prevention. 

13 ‘‘(iii) Supporting early detection and 

14 diagnosis of Alzheimer’s disease. 

15 ‘‘(iv) Reducing the risk of potentially 

16 avoidable hospitalizations of individuals 

17 with Alzheimer’s disease. 

18 ‘‘(v) Reducing the risk of cognitive de19 cline and cognitive impairment, including 

20 Alzheimer’s disease. 

21 ‘‘(vi) Enhancing support to meet the 

22 needs of caregivers of individuals with Alz23 heimer’s disease. 

24 ‘‘(vii) Reducing health disparities re25 lated to the care and support of individuals 


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1 with cognitive decline and Alzheimer’s dis2 ease. 

3 ‘‘(viii) Supporting care planning and 

4 management for individuals with Alz5 heimer’s disease. 

6 ‘‘(3) CONSIDERATIONS.—In awarding coopera7 tive agreements under this subsection, the Secretary 

8 shall consider, among other factors, whether the en9 tity— 

10 ‘‘(A) has access to rural areas or other un11 derserved populations; 

12 ‘‘(B) is located in an area where the aggre13 gate success rate for applications for National 

14 Institutes of Health funding has been histori15 cally low; 

16 ‘‘(C) is able to build on an existing infra17 structure of service and public health research; 

18 ‘‘(D) has experience with providing care, 

19 caregiver support, and research related to Alz20 heimer’s disease; and 

21 ‘‘(E) is integrated into existing local gov22 ernment and public health infrastructures. 

23 ‘‘(4) DISTRIBUTION OF AWARDS.—In awarding 

24 cooperative agreements under this subsection, the 

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1 uitable distribution of awards based on geographic 

2 area, including consideration of rural areas, and the 

3 burden of the disease on sub-populations. 

4 ‘‘(d) COOPERATIVE AGREEMENTS TO PUBLIC

5 HEALTH DEPARTMENTS.— 

6 ‘‘(1) IN GENERAL.—The Secretary shall award 

7 cooperative agreements to health departments of 

8 States, of political subdivisions of States, and of In9 dian tribes and tribal organizations to promote cog10 nitive functioning, address cognitive impairment for 

11 individuals living in such communities, help meet the 

12 needs of caregivers, and address unique aspects of 

13 Alzheimer’s disease, as follows: 

14 ‘‘(A) The Secretary shall award core ca15 pacity cooperative agreements to such health 

16 departments to support the development and 

17 implementation of systems change, communica18 tions, and programmatic interventions with re19 spect to Alzheimer’s disease, including activities 

20 involving— 

21 ‘‘(i) educating and informing the pub22 lic based on established public health re23 search and data; 

24 ‘‘(ii) supporting early detection and 

25 diagnosis; 


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1 ‘‘(iii) reducing the risk of potentially 

2 avoidable hospitalizations; 

3 ‘‘(iv) reducing the risk of cognitive de4 cline and cognitive impairment; 

5 ‘‘(v) enhancing support to meet the 

6 needs of caregivers; 

7 ‘‘(vi) supporting care planning and 

8 management; or 

9 ‘‘(vii) supporting the actions set forth 

10 in the most current version of the ‘Healthy 

11 Brain Initiative: Public Health Road Map’ 

12 of the Centers for Disease Control and 

13 Prevention. 

14 ‘‘(B) The Secretary shall award not less 

15 than 5 enhanced activity cooperative agree16 ments to such health departments to carry out 

17 activities related to Alzheimer’s disease, includ18 ing through public-private partnerships with or19 ganizations or other agencies, such as large em20 ployers, public housing agencies, large health 

21 care systems, and parks and recreation depart22 ments, that include— 

23 ‘‘(i) expanding implementation of pro24 grams described in paragraph (2)(A) to 


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1 reach larger segments of the population; 

2 and 

3 ‘‘(ii) implementing the reports de4 scribed in subparagraph (A)(vii). 

5 ‘‘(2) OTHER CONSIDERATIONS.— 

6 ‘‘(A) PREFERENCE.—In awarding coopera7 tive agreements under paragraph (1), the Sec8 retary shall give preference to applications that 

9 focus on addressing health disparities, including 

10 populations and geographic areas that are most 

11 in need of intervention. 

12 ‘‘(B) CLARIFICATION ON ENHANCED AC13 TIVITY COOPERATIVE AGREEMENTS.—If the 

14 Secretary is unable to identify 5 eligible health 

15 departments to receive a cooperative agreement 

16 under paragraph (1)(B), the Secretary shall al17 locate any amounts reserved for such agree18 ments to additional cooperative agreements 

19 under paragraph (1)(A). 

20 ‘‘(3) ELIGIBILITY.—To be eligible to receive a 

21 cooperative agreement under paragraph (1), a State, 

22 political subdivision of a State, Indian tribe, or tribal 

23 organization shall prepare and submit to the Sec24 retary an application at such time, in such manner, 


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1 and containing such information as the Secretary 

2 may require, including a plan that describes— 

3 ‘‘(A) how the applicant proposes to develop 

4 or expand, programs to educate individuals 

5 through partnership engagement, workforce de6 velopment, guidance and support for pro7 grammatic efforts, strategic communication, 

8 and evaluation with respect to Alzheimer’s dis9 ease, and in the case of a cooperative agree10 ment under paragraph (1)(B), how the appli11 cant proposes to implement the most current 

12 version of the ‘Healthy Brain Initiative: Public 

13 Health Road Map’ of the Centers for Disease 

14 Control and Prevention; 

15 ‘‘(B) the manner in which the applicant 

16 will coordinate with appropriate State and local 

17 authorities as well as, in the case of a coopera18 tive agreement under paragraph (1)(B), rel19 evant public and private organizations or agen20 cies; and 

21 ‘‘(C) the manner in which the applicant 

22 will evaluate the effectiveness of any program 

23 carried out under the cooperative agreement. 

24 ‘‘(4) USE OF FUNDS.—A health department 

25 awarded a cooperative agreement under paragraph 


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1 (1) shall use amounts received under such coopera2 tive agreement to— 

3 ‘‘(A) develop, implement, disseminate, 

4 evaluate, and if applicable, expand programs to 

5 educate individuals on matters related to Alz6 heimer’s disease described in paragraph (1)(A); 

7 and 

8 ‘‘(B) in the case of a cooperative agree9 ment under paragraph (1)(B), implement the 

10 most current version of the ‘Healthy Brain Ini11 tiative: Public Health Road Map’ of the Centers 

12 for Disease Control and Prevention and evalu13 ate its implementation. 

14 ‘‘(5) MATCHING REQUIREMENT.— 

15 ‘‘(A) IN GENERAL.—Except as may be pro16 vided in subparagraph (B), each health depart17 ment that is awarded a cooperative agreement 

18 under paragraph (1) shall provide, from non19 Federal sources, an amount equal to 15 percent 

20 of the amount provided under such agreement 

21 (which may be provided in cash or in-kind) to 

22 carry out the activities supported by the cooper23 ative agreement. 

24 ‘‘(B) WAIVER AUTHORITY.—The Secretary 

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1 ment described in subparagraph (A) for any fis2 cal year for— 

3 ‘‘(i) a health department, if the Sec4 retary determines that applying such 

5 matching requirement to the health depart6 ment would result in serious hardship or 

7 an inability to carry out the purposes of 

8 the cooperative agreement awarded to such 

9 health department; or 

10 ‘‘(ii) a rural or frontier region. 

11 ‘‘(e) COOPERATIVE AGREEMENTS FOR ANALYSIS AND

12 REPORTING OF DATA REGARDING COGNITIVE DECLINE

13 AND CAREGIVING.— 

14 ‘‘(1) IN GENERAL.—The Secretary may award 

15 cooperative agreements to eligible entities for the fol16 lowing activities: 

17 ‘‘(A) The analysis and timely public re18 porting of data on the State and national levels 

19 regarding cognitive decline, including Alz20 heimer’s disease, caregiving, and health dispari21 ties experienced by individuals with cognitive 

22 decline and their caregivers. 

23 ‘‘(B) The monitoring of objectives on de24 mentia, including Alzheimer’s disease, and 

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1 garding health-status goals for 2020 (commonly 

2 referred to as the ‘Healthy People 2020 re3 port’), and the development and monitoring of 

4 such objectives in future Healthy People reports 

5 of the Department of Health and Human Serv6 ices. 

7 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

8 cooperative agreement under this subsection, an en9 tity shall be a public or nonprofit private entity, in10 cluding institutions of higher education, and submit 

11 to the Secretary an application at such time, in such 

12 manner, and containing such information as the Sec13 retary may require. 

14 ‘‘(3) SURVEILLANCE.—The analysis, timely 

15 public reporting, and dissemination of data regard16 ing cognitive decline, cognitive impairment, caregiv17 ing, and health disparities on the State and national 

18 levels under a cooperative agreement under this sub19 section may be carried out by eligible entities using 

20 data sources such as the following: 

21 ‘‘(A) The Behavioral Risk Factor Surveil22 lance System. 

23 ‘‘(B) The National Health and Nutrition 

24 Examination Survey. 


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1 ‘‘(C) The National Health Interview Sur2 vey. 

3 ‘‘(f) DATA COLLECTION.—The Secretary shall collect 

4 data on cognitive decline, cognitive impairment, caregiv5 ing, and health disparities on the State and national levels, 

6 using the surveillance systems described in subparagraphs 

7 (A) through (C) of subsection (e)(3). 

8 ‘‘(g) NONDUPLICATION OF EFFORT.—The Secretary 

9 shall ensure that activities under any cooperative agree10 ment awarded under this section do not unnecessarily du11 plicate efforts of other agencies and offices within the De12 partment of Health and Human Services related to— 

13 ‘‘(1) activities of centers of excellence in public 

14 health practice with respect to Alzheimer’s disease 

15 described in subsection (c); 

16 ‘‘(2) activities of public health departments with 

17 respect to Alzheimer’s disease described in sub18 section (d); or 

19 ‘‘(3) the analysis and public reporting of sur20 veillance data on cognitive decline, caregiving, and 

21 health disparities of individuals with Alzheimer’s dis22 ease under subsection (e). 

23 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—For 

24 each of fiscal years 2018 through 2025, there are author25 ized to be appropriated $12,000,000 for purposes of carVerDate Sep 11 2014 23:58 Nov 29, 2018 Jkt 089200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6401 E:\BILLS\S2076.RS S2076

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1 rying out subsection (c), $20,000,000 for purposes of car2 rying out subsection (d), and $5,000,000 for purposes of 

3 carrying out subsections (e) and (f). Funds appropriated 

4 under this subsection shall remain available until ex5 pended.’’. 

6 SECTION 1. SHORT TITLE. 

7 This Act may be cited as the ‘‘Building Our Largest 

8 Dementia Infrastructure for Alzheimer’s Act’’ or the 

9 ‘‘BOLD Infrastructure for Alzheimer’s Act’’. 

10 SEC. 2. PROMOTION OF PUBLIC HEALTH KNOWLEDGE AND 

11 AWARENESS OF ALZHEIMER’S DISEASE, COG12 NITIVE DECLINE, AND BRAIN HEALTH UNDER 

13 THE ALZHEIMER’S DISEASE AND HEALTHY 

14 AGING PROGRAM. 

15 Part K of title III of the Public Health Service Act 

16 (42 U.S.C. 280c et seq.) is amended— 

17 (1) in the part heading, by adding ‘‘AND PUB18 LIC HEALTH PROGRAMS FOR DEMENTIA’’ at the 

19 end; and 

20 (2) in subpart II— 

21 (A) by striking the subpart heading and in22 serting the following: 


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1 ‘‘Subpart II—Programs With Respect to Alzheimer’s 

2 Disease and Related Dementias’’; and 

3 (B) by striking section 398A (42 U.S.C. 

4 280c-4) and inserting the following: 

5 ‘‘SEC. 398A. PROMOTION OF PUBLIC HEALTH KNOWLEDGE 

6 AND AWARENESS OF ALZHEIMER’S DISEASE 

7 AND RELATED DEMENTIAS. 

8 ‘‘(a) ALZHEIMER’S DISEASE AND RELATED DEMEN9 TIAS PUBLIC HEALTH CENTERS OF EXCELLENCE.— 

10 ‘‘(1) IN GENERAL.—The Secretary, in coordina11 tion with the Director of the Centers for Disease Con12 trol and Prevention and the heads of other agencies 

13 as appropriate, shall award grants, contracts, or co14 operative agreements to eligible entities, such as insti15 tutions of higher education, State, tribal, and local 

16 health departments, Indian tribes, tribal organiza17 tions, associations, or other appropriate entities for 

18 the establishment or support of regional centers to ad19 dress Alzheimer’s disease and related dementias by— 

20 ‘‘(A) advancing the awareness of public 

21 health officials, health care professionals, and the 

22 public, on the most current information and re23 search related to Alzheimer’s disease and related 

24 dementias, including cognitive decline, brain 

25 health, and associated health disparities; 


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1 ‘‘(B) identifying and translating promising 

2 research findings, such as findings from research 

3 and activities conducted or supported by the Na4 tional Institutes of Health, including Alzheimer’s 

5 Disease Research Centers authorized by section 

6 445, into evidence-based programmatic interven7 tions for populations with Alzheimer’s disease 

8 and related dementias and caregivers for such 

9 populations; and 

10 ‘‘(C) expanding activities, including 

11 through public-private partnerships related to 

12 Alzheimer’s disease and related dementias and 

13 associated health disparities. 

14 ‘‘(2) REQUIREMENTS.—To be eligible to receive a 

15 grant, contract, or cooperative agreement under this 

16 subsection, an entity shall submit to the Secretary an 

17 application containing such agreements and informa18 tion as the Secretary may require, including a de19 scription of how the entity will— 

20 ‘‘(A) coordinate, as applicable, with existing 

21 Federal, State, and tribal programs related to 

22 Alzheimer’s disease and related dementias; 

23 ‘‘(B) examine, evaluate, and promote evi24 dence-based interventions for individuals with 

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1 cluding underserved populations with such con2 ditions, and those who provide care for such in3 dividuals; and 

4 ‘‘(C) prioritize activities relating to— 

5 ‘‘(i) expanding efforts, as appropriate, 

6 to implement evidence-based practices to ad7 dress Alzheimer’s disease and related de8 mentias, including through the training of 

9 State, local, and tribal public health offi10 cials and other health professionals on such 

11 practices; 

12 ‘‘(ii) supporting early detection and 

13 diagnosis of Alzheimer’s disease and related 

14 dementias; 

15 ‘‘(iii) reducing the risk of potentially 

16 avoidable hospitalizations of individuals 

17 with Alzheimer’s disease and related demen18 tias; 

19 ‘‘(iv) reducing the risk of cognitive de20 cline and cognitive impairment associated 

21 with Alzheimer’s disease and related demen22 tias; 

23 ‘‘(v) enhancing support to meet the 

24 needs of caregivers of individuals with Alz25 heimer’s disease and related dementias; 


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1 ‘‘(vi) reducing health disparities re2 lated to the care and support of individuals 

3 with Alzheimer’s disease and related demen4 tias; 

5 ‘‘(vii) supporting care planning and 

6 management for individuals with Alz7 heimer’s disease and related dementias; and 

8 ‘‘(viii) supporting other relevant ac9 tivities identified by the Secretary or the 

10 Director of the Centers for Disease Control 

11 and Prevention, as appropriate. 

12 ‘‘(3) CONSIDERATIONS.—In awarding grants, 

13 contracts, and cooperative agreements under this sub14 section, the Secretary shall consider, among other fac15 tors, whether the entity— 

16 ‘‘(A) provides services to rural areas or 

17 other underserved populations; 

18 ‘‘(B) is able to build on an existing infra19 structure of services and public health research; 

20 and 

21 ‘‘(C) has experience with providing care or 

22 caregiver support, or has experience conducting 

23 research related to Alzheimer’s disease and re24 lated dementias. 


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1 ‘‘(4) DISTRIBUTION OF AWARDS.—In awarding 

2 grants, contracts, or cooperative agreements under 

3 this subsection, the Secretary, to the extent prac4 ticable, shall ensure equitable distribution of awards 

5 based on geographic area, including consideration of 

6 rural areas, and the burden of the disease within sub7 populations. 

8 ‘‘(5) DATA REPORTING AND PROGRAM OVER9 SIGHT.—With respect to a grant, contract, or coopera10 tive agreement awarded under this subsection, not 

11 later than 90 days after the end of the first year of 

12 the period of assistance, and annually thereafter for 

13 the duration of the grant, contract, or agreement (in14 cluding the duration of any renewal period as pro15 vided for under paragraph (5)), the entity shall sub16 mit data, as appropriate, to the Secretary regard17 ing— 

18 ‘‘(A) the programs and activities funded 

19 under the grant, contract, or agreement; and 

20 ‘‘(B) outcomes related to such programs and 

21 activities. 

22 ‘‘(b) IMPROVING DATA ON STATE AND NATIONAL

23 PREVALENCE OF ALZHEIMER’S DISEASE AND RELATED

24 DEMENTIAS.— 


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1 ‘‘(1) IN GENERAL.—The Secretary shall, as ap2 propriate, improve the analysis and timely reporting 

3 of data on the incidence and prevalence of Alzheimer’s 

4 disease and related dementias. Such data may in5 clude, as appropriate, information on cognitive de6 cline, caregiving, and health disparities experienced 

7 by individuals with cognitive decline and their care8 givers. The Secretary may award grants, contracts, or 

9 cooperative agreements to eligible entities for activi10 ties under this paragraph. 

11 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

12 grant, contract, or cooperative agreement under this 

13 subsection, an entity shall be a public or nonprofit 

14 private entity, including institutions of higher edu15 cation, State, local, and tribal health departments, 

16 and Indian tribes and tribal organizations, and sub17 mit to the Secretary an application at such time, in 

18 such manner, and containing such information as the 

19 Secretary may require. 

20 ‘‘(3) DATA SOURCES.—The analysis, timely pub21 lic reporting, and dissemination of data under this 

22 subsection may be carried out using data sources such 

23 as the following: 

24 ‘‘(A) The Behavioral Risk Factor Surveil25 lance System. 


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1 ‘‘(B) The National Health and Nutrition 

2 Examination Survey. 

3 ‘‘(C) The National Health Interview Sur4 vey. 

5 ‘‘(c) IMPROVED COORDINATION.—The Secretary shall 

6 ensure that activities and programs related to dementia 

7 under this section do not unnecessarily duplicate activities 

8 and programs of other agencies and offices within the De9 partment of Health and Human Services.’’. 

10 SEC. 3. SUPPORTING STATE PUBLIC HEALTH PROGRAMS 

11 RELATED TO ALZHEIMER’S DISEASE AND RE12 LATED DEMENTIAS. 

13 Section 398 of the Public Health Service Act (42 

14 U.S.C. 280c-3) is amended— 

15 (1) in the section heading, by striking ‘‘ESTAB16 LISHMENT OF PROGRAM’’ and inserting ‘‘COOP17 ERATIVE AGREEMENTS TO STATES AND PUBLIC

18 HEALTH DEPARTMENTS FOR ALZHEIMER’S DIS19 EASE AND RELATED DEMENTIAS’’; 

20 (2) by striking subsection (a) and inserting the 

21 following: 

22 ‘‘(a) IN GENERAL.—The Secretary, in coordination 

23 with the Director of the Centers for Disease Control and 

24 Prevention and the heads of other agencies, as appropriate, 

25 shall award cooperative agreements to health departments 


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1 of States, political subdivisions of States, and Indian tribes 

2 and tribal organizations, to address Alzheimer’s disease and 

3 related dementias, including by reducing cognitive decline, 

4 helping meet the needs of caregivers, and addressing unique 

5 aspects of Alzheimer’s disease and related dementias to sup6 port the development and implementation of evidence-based 

7 interventions with respect to— 

8 ‘‘(1) educating and informing the public, based 

9 on evidence-based public health research and data, 

10 about Alzheimer’s disease and related dementias; 

11 ‘‘(2) supporting early detection and diagnosis; 

12 ‘‘(3) reducing the risk of potentially avoidable 

13 hospitalizations for individuals with Alzheimer’s dis14 ease and related dementias; 

15 ‘‘(4) reducing the risk of cognitive decline and 

16 cognitive impairment associated with Alzheimer’s dis17 ease and related dementias; 

18 ‘‘(5) improving support to meet the needs of 

19 caregivers of individuals with Alzheimer’s disease and 

20 related dementias; 

21 ‘‘(6) supporting care planning and management 

22 for individuals with Alzheimer’s disease and related 

23 dementias. 

24 ‘‘(7) supporting other relevant activities identi25 fied by the Secretary or the Director of the Centers for 


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1 Disease Control and Prevention, as appropriate’’.; 

2 and 

3 (3) by striking subsection (b); 

4 (4) by redesignating subsection (c) as subsection 

5 (g); 

6 (5) by inserting after subsection (a), the fol7 lowing: 

8 ‘‘(b) PREFERENCE.—In awarding cooperative agree9 ments under this section, the Secretary shall give preference 

10 to applications that focus on addressing health disparities, 

11 including populations and geographic areas that have the 

12 highest prevalence of Alzheimer’s disease and related demen13 tias. 

14 ‘‘(c) ELIGIBILITY.—To be eligible to receive a coopera15 tive agreement under this section, an eligible entity (pursu16 ant to subsection (a)) shall prepare and submit to the Sec17 retary an application at such time, in such manner, and 

18 containing such information as the Secretary may require, 

19 including a plan that describes— 

20 ‘‘(1) how the applicant proposes to develop or ex21 pand, programs to educate individuals through part22 nership engagement, workforce development, guidance 

23 and support for programmatic efforts, and evaluation 

24 with respect to Alzheimer’s disease and related demen25 tias, and in the case of a cooperative agreement under 


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1 this section, how the applicant proposes to support 

2 other relevant activities identified by the Secretary or 

3 Director of the Centers for Disease Control and Pre4 vention, as appropriate. 

5 ‘‘(2) the manner in which the applicant will co6 ordinate with Federal, tribal, and State programs re7 lated to Alzheimer’s disease and related dementias, 

8 and appropriate State, tribal, and local agencies, as 

9 well as other relevant public and private organiza10 tions or agencies; and 

11 ‘‘(3) the manner in which the applicant will 

12 evaluate the effectiveness of any program carried out 

13 under the cooperative agreement. 

14 ‘‘(d) MATCHING REQUIREMENT.—Each health depart15 ment that is awarded a cooperative agreement under sub16 section (a) shall provide, from non-Federal sources, an 

17 amount equal to 30 percent of the amount provided under 

18 such agreement (which may be provided in cash or in-kind) 

19 to carry out the activities supported by the cooperative 

20 agreement. 

21 ‘‘(e) WAIVER AUTHORITY.—The Secretary may waive 

22 all or part of the matching requirement described in sub23 section (d) for any fiscal year for— 

24 ‘‘(1) a health department of a State, political 

25 subdivision of a State, or Indian tribe and tribal orVerDate Sep 11 2014 23:58 Nov 29, 2018 Jkt 089200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6203 E:\BILLS\S2076.RS S2076

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1 ganization, if the Secretary determines that applying 

2 such matching requirement would result in serious 

3 hardship or an inability to carry out the purposes of 

4 the cooperative agreement awarded to such health de5 partment of a State, political subdivision of a State, 

6 or Indian tribe and tribal organization; or 

7 ‘‘(2) a health department of a State, political 

8 subdivision of a State, or Indian tribe and tribal or9 ganization located in a rural area or frontier area.’’; 

10 (6) in subsection (f) (as so redesignated), by 

11 striking ‘‘grant’’ and inserting ‘‘cooperative agree12 ment’’; and 

13 (7) by adding at the end the following: 

14 ‘‘(f) NON-DUPLICATION OF EFFORT.—The Secretary 

15 shall ensure that activities under any cooperative agreement 

16 awarded under this subpart do not unnecessarily duplicate 

17 efforts of other agencies and offices within the Department 

18 of Health and Human Services related to— 

19 ‘‘(1) activities of centers of excellence with respect 

20 to Alzheimer’s disease and related dementias described 

21 in section 398A; and 

22 ‘‘(2) activities of public health departments with 

23 respect to Alzheimer’s disease and related dementias 

24 described in this section.’’. 


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1 SEC. 4. ADDITIONAL PROVISIONS. 

2 Section 398B of the Public Health Service Act (42 

3 U.S.C. 280c-5) is amended— 

4 (1) in subsection (a)— 

5 (A) by inserting ‘‘or cooperative agreement’’ 

6 after ‘‘grant’’ each place that such appears; 

7 (B) by striking ‘‘section 398(a) to a State 

8 unless the State’’ and inserting ‘‘sections 398 or 

9 398A to an entity unless the entity’’; and 

10 (C) by striking ‘‘10’’ and inserting ‘‘5’’; 

11 (2) by striking subsection (b); 

12 (3) by redesignating subsections (c) and (d) as 

13 subsections (b) and (c), respectively; 

14 (4) in subsection (b) (as so redesignated)— 

15 (A) in the matter preceding paragraph (1), 

16 by striking ‘‘section 398(a) to a State unless the 

17 State’’ and inserting ‘‘sections 398 or 398A to an 

18 entity unless the entity’’; 

19 (B) in paragraph (1), by striking ‘‘expendi20 tures required in subsection (b);’’ and inserting 

21 ‘‘expenditures;’’; 

22 (5) in subsection (c) (as so redesignated)— 

23 (A) in paragraph (1)— 

24 (i) by striking ‘‘each demonstration 

25 project for which a grant’’ and inserting 

26 ‘‘the activities for which an award’’; and 


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1 (ii) by striking ‘‘section 398(a)’’ and 

2 inserting ‘‘sections 398 or 398A’’; and 

3 (B) in paragraph (2), by striking ‘‘6 

4 months’’ and inserting ‘‘1 year’’; 

5 (6) by inserting after subsection (c) (as so redes6 ignated), the following: 

7 ‘‘(d) DEFINITION.—In this subpart, the terms ‘Indian 

8 tribe’ and ‘tribal organization’ have the meanings given 

9 such terms in section 4 of the Indian Health Care Improve10 ment Act.’’; and 

11 (7) in subsection (e), by striking ‘‘$5,000,000 for 

12 each of the fiscal years 1988 through 1990’’ and all 

13 that follows through ‘‘2002’’ and inserting 

14 ‘‘$20,000,000 for each of fiscal years 2020 through 

15 2024’’. 


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Calendar No. 694 

115TH CONGRESS 

2D SESSION S. 2076 

A BILL 

To amend the Public Health Service Act to authorHealthy Aging Program, and for other purposes. health under the Alzheimer’s Disease and heimer’s disease, cognitive decline, and brain ize the expansion of activities related to AlzNOVEMBER 29, 2018 

Reported with an amendment 


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