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[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 2076 Reported in Senate (RS)]

<DOC>

                                                       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, cognitive decline, and brain 
health under the Alzheimer's Disease and Healthy Aging Program, and for 
                            other purposes.

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

<DELETED>SECTION 1. SHORT TITLE.</DELETED>

<DELETED>    This Act may be cited as the ``Building Our Largest 
Dementia Infrastructure for Alzheimer's Act'' or the ``BOLD 
Infrastructure for Alzheimer's Act''.</DELETED>

<DELETED>SEC. 2. FINDINGS.</DELETED>

<DELETED>    Congress finds as follows:</DELETED>
        <DELETED>    (1) According to former Surgeon General and 
        Director of the Centers for Disease Control and Prevention, Dr. 
        David Satcher, ``Alzheimer's is the most under-recognized 
        threat to public health in the 21st century.''.</DELETED>
        <DELETED>    (2) Deaths from Alzheimer's disease increased 55 
        percent between 1999 and 2014 in the United States, according 
        to data from the Centers for Disease Control and 
        Prevention.</DELETED>
        <DELETED>    (3) More than 5,000,000 people in the United 
        States are living with Alzheimer's disease and, without 
        significant efforts to change the current trajectory, as many 
        as 16,000,000 people in the United States will have Alzheimer's 
        disease by 2050. This explosive growth will cause costs 
        associated with Alzheimer's disease to increase from an 
        estimated $259,000,000,000 in 2017 to more than 
        $1,100,000,000,000 in 2050 (in 2017 dollars).</DELETED>
        <DELETED>    (4) Among individuals living with Alzheimer's 
        disease and other dementias, evidence indicates as many as 50 
        percent have not been diagnosed. Among individuals diagnosed 
        with Alzheimer's disease, only 33 percent are aware of the 
        diagnosis. Early detection and diagnosis of Alzheimer's disease 
        and other dementias allow people to access available 
        treatments, build a care team, participate in support services, 
        and enroll in clinical trials. Early detection can help 
        physicians better manage a patient's comorbid conditions and 
        avoid prescribing medications that may worsen cognition or 
        function.</DELETED>
        <DELETED>    (5) Among individuals living with Alzheimer's 
        disease and other dementias, 25.3 percent experience a 
        preventable hospitalization, and such preventable 
        hospitalizations cost the Medicare program nearly 
        $2,600,000,000 in 2013.</DELETED>
        <DELETED>    (6) African Americans are about 2 times more 
        likely than White Americans to have Alzheimer's disease and 
        other dementias. Hispanics are about one and one-half times 
        more likely than White Americans to have Alzheimer's disease 
        and other dementias.</DELETED>
        <DELETED>    (7) In 2016, 15,900,000 family members and friends 
        provided 18,200,000,000 hours of unpaid care to individuals 
        with Alzheimer's disease and other dementias, at an economic 
        value of over $230,000,000,000. The physical and emotional 
        impact of caregiving of individuals with Alzheimer's disease 
        and other dementia resulted in an estimated $10,900,000,000 in 
        increased caregiver health costs in 2016.</DELETED>
        <DELETED>    (8) Strategy 4.B of the ``National Plan to Address 
        Alzheimer's Disease: 2017 Update'' of the Office of the 
        Assistant Secretary for Planning and Evaluation of the 
        Department of Health and Human Services is to ``work with 
        State, Tribal, and local governments to improve coordination 
        and identify model initiatives to advance Alzheimer's disease 
        awareness and readiness across the Government.''.</DELETED>

<DELETED>SEC. 3. PROMOTION OF PUBLIC HEALTH KNOWLEDGE AND AWARENESS OF 
              ALZHEIMER'S DISEASE, COGNITIVE DECLINE, AND BRAIN HEALTH 
              UNDER THE ALZHEIMER'S DISEASE AND HEALTHY AGING 
              PROGRAM.</DELETED>

<DELETED>    Part P of title III of the Public Health Service Act (42 
U.S.C. 280g et seq.) is amended by adding at the end the 
following:</DELETED>

<DELETED>``SEC. 399V-7. PROMOTION OF PUBLIC HEALTH KNOWLEDGE AND 
              AWARENESS OF ALZHEIMER'S DISEASE, COGNITIVE DECLINE, AND 
              BRAIN HEALTH UNDER THE ALZHEIMER'S DISEASE AND HEALTHY 
              AGING PROGRAM.</DELETED>

<DELETED>    ``(a) Definitions.--In the section:</DELETED>
        <DELETED>    ``(1) Alzheimer's disease.--The term `Alzheimer's 
        disease' means Alzheimer's disease and related 
        dementias.</DELETED>
        <DELETED>    ``(2) Indian tribe; tribal organization.--The 
        terms `Indian tribe' and `tribal organization' have the 
        meanings given such terms in section 4 of the Indian Health 
        Care Improvement Act.</DELETED>
<DELETED>    ``(b) Expansion of Activities Under the Alzheimer's 
Disease and Healthy Aging Program.--In addition to activities conducted 
by the Secretary under the Alzheimer's Disease and Healthy Aging 
Program of the Centers for Disease Control and Prevention, the 
Secretary, acting through the Director of the Centers for Disease 
Control and Prevention, subject to appropriations under subsection (g), 
shall award cooperative agreements under subsections (c), (d), and 
(e).</DELETED>
<DELETED>    ``(c) Centers of Excellence in Public Health Practice.--
</DELETED>
        <DELETED>    ``(1) In general.--The Secretary shall award 
        cooperative agreements to eligible entities for the 
        establishment or support of national or regional centers of 
        excellence in public health practice in Alzheimer's disease 
        to--</DELETED>
                <DELETED>    ``(A) advance the education of public 
                health officials of States, of political subdivisions 
                of States, and of Indian tribes or tribal 
                organizations, health care professionals, and the 
                public on Alzheimer's disease, cognitive decline, brain 
                health, and associated health disparities;</DELETED>
                <DELETED>    ``(B) advance the efforts of public health 
                officials referred to in subparagraph (A) in applying 
                evidence-based systems change, communications, and 
                programmatic interventions for populations with 
                cognitive impairment, including Alzheimer's disease, 
                and caregivers for such populations; and</DELETED>
                <DELETED>    ``(C) expand public-private partnerships 
                engaged in activities related to cognitive impairment 
                and associated health disparities with demonstrated 
                success or innovative programs (as determined by the 
                Secretary).</DELETED>
        <DELETED>    ``(2) Requirements.--To be eligible to receive a 
        cooperative agreement under this subsection, an entity shall 
        submit to the Secretary an application containing such 
        agreements and information as the Secretary may require, 
        including an agreement that the center to be established or 
        supported under the cooperative agreement will operate in 
        accordance with the following:</DELETED>
                <DELETED>    ``(A) The center will examine, evaluate, 
                increase, and promote evidence-based and effective 
                Alzheimer's disease and caregiving-related 
                interventions for health and social services 
                professionals, underserved populations, families, and 
                the public, after consultation with relevant State and 
                local public health officials, private-sector 
                Alzheimer's disease researchers, and advocates for 
                individuals with Alzheimer's disease.</DELETED>
                <DELETED>    ``(B) The center will prioritize its 
                activities on the following:</DELETED>
                        <DELETED>    ``(i) Expanding efforts to educate 
                        State, local, and tribal officials and public 
                        health professionals in applying established 
                        data and evidence-based best practices to 
                        address Alzheimer's disease.</DELETED>
                        <DELETED>    ``(ii) Supporting public health 
                        officials of States, of political subdivisions 
                        of States, and of Indian tribes or tribal 
                        organizations in implementing the most current 
                        version of the `Healthy Brain Initiative: 
                        Public Health Road Map' of the Centers for 
                        Disease Control and Prevention.</DELETED>
                        <DELETED>    ``(iii) Supporting early detection 
                        and diagnosis of Alzheimer's disease.</DELETED>
                        <DELETED>    ``(iv) Reducing the risk of 
                        potentially avoidable hospitalizations of 
                        individuals with Alzheimer's disease.</DELETED>
                        <DELETED>    ``(v) Reducing the risk of 
                        cognitive decline and cognitive impairment, 
                        including Alzheimer's disease.</DELETED>
                        <DELETED>    ``(vi) Enhancing support to meet 
                        the needs of caregivers of individuals with 
                        Alzheimer's disease.</DELETED>
                        <DELETED>    ``(vii) Reducing health 
                        disparities related to the care and support of 
                        individuals with cognitive decline and 
                        Alzheimer's disease.</DELETED>
                        <DELETED>    ``(viii) Supporting care planning 
                        and management for individuals with Alzheimer's 
                        disease.</DELETED>
        <DELETED>    ``(3) Considerations.--In awarding cooperative 
        agreements under this subsection, the Secretary shall consider, 
        among other factors, whether the entity--</DELETED>
                <DELETED>    ``(A) has access to rural areas or other 
                underserved populations;</DELETED>
                <DELETED>    ``(B) is located in an area where the 
                aggregate success rate for applications for National 
                Institutes of Health funding has been historically 
                low;</DELETED>
                <DELETED>    ``(C) is able to build on an existing 
                infrastructure of service and public health 
                research;</DELETED>
                <DELETED>    ``(D) has experience with providing care, 
                caregiver support, and research related to Alzheimer's 
                disease; and</DELETED>
                <DELETED>    ``(E) is integrated into existing local 
                government and public health infrastructures.</DELETED>
        <DELETED>    ``(4) Distribution of awards.--In awarding 
        cooperative agreements under this subsection, the Secretary, to 
        the extent practicable, shall ensure equitable distribution of 
        awards based on geographic area, including consideration of 
        rural areas, and the burden of the disease on sub-
        populations.</DELETED>
<DELETED>    ``(d) Cooperative Agreements to Public Health 
Departments.--</DELETED>
        <DELETED>    ``(1) In general.--The Secretary shall award 
        cooperative agreements to health departments of States, of 
        political subdivisions of States, and of Indian tribes and 
        tribal organizations to promote cognitive functioning, address 
        cognitive impairment for individuals living in such 
        communities, help meet the needs of caregivers, and address 
        unique aspects of Alzheimer's disease, as follows:</DELETED>
                <DELETED>    ``(A) The Secretary shall award core 
                capacity cooperative agreements to such health 
                departments to support the development and 
                implementation of systems change, communications, and 
                programmatic interventions with respect to Alzheimer's 
                disease, including activities involving--</DELETED>
                        <DELETED>    ``(i) educating and informing the 
                        public based on established public health 
                        research and data;</DELETED>
                        <DELETED>    ``(ii) supporting early detection 
                        and diagnosis;</DELETED>
                        <DELETED>    ``(iii) reducing the risk of 
                        potentially avoidable 
                        hospitalizations;</DELETED>
                        <DELETED>    ``(iv) reducing the risk of 
                        cognitive decline and cognitive 
                        impairment;</DELETED>
                        <DELETED>    ``(v) enhancing support to meet 
                        the needs of caregivers;</DELETED>
                        <DELETED>    ``(vi) supporting care planning 
                        and management; or</DELETED>
                        <DELETED>    ``(vii) supporting the actions set 
                        forth in the most current version of the 
                        `Healthy Brain Initiative: Public Health Road 
                        Map' of the Centers for Disease Control and 
                        Prevention.</DELETED>
                <DELETED>    ``(B) The Secretary shall award not less 
                than 5 enhanced activity cooperative agreements to such 
                health departments to carry out activities related to 
                Alzheimer's disease, including through public-private 
                partnerships with organizations or other agencies, such 
                as large employers, public housing agencies, large 
                health care systems, and parks and recreation 
                departments, that include--</DELETED>
                        <DELETED>    ``(i) expanding implementation of 
                        programs described in paragraph (2)(A) to reach 
                        larger segments of the population; 
                        and</DELETED>
                        <DELETED>    ``(ii) implementing the reports 
                        described in subparagraph (A)(vii).</DELETED>
        <DELETED>    ``(2) Other considerations.--</DELETED>
                <DELETED>    ``(A) Preference.--In awarding cooperative 
                agreements under paragraph (1), the Secretary shall 
                give preference to applications that focus on 
                addressing health disparities, including populations 
                and geographic areas that are most in need of 
                intervention.</DELETED>
                <DELETED>    ``(B) Clarification on enhanced activity 
                cooperative agreements.--If the Secretary is unable to 
                identify 5 eligible health departments to receive a 
                cooperative agreement under paragraph (1)(B), the 
                Secretary shall allocate any amounts reserved for such 
                agreements to additional cooperative agreements under 
                paragraph (1)(A).</DELETED>
        <DELETED>    ``(3) Eligibility.--To be eligible to receive a 
        cooperative agreement under paragraph (1), a State, political 
        subdivision of a State, Indian tribe, or tribal organization 
        shall prepare and submit to the Secretary an application at 
        such time, in such manner, and containing such information as 
        the Secretary may require, including a plan that describes--
        </DELETED>
                <DELETED>    ``(A) how the applicant proposes to 
                develop or expand, programs to educate individuals 
                through partnership engagement, workforce development, 
                guidance and support for programmatic efforts, 
                strategic communication, and evaluation with respect to 
                Alzheimer's disease, and in the case of a cooperative 
                agreement under paragraph (1)(B), how the applicant 
                proposes to implement the most current version of the 
                `Healthy Brain Initiative: Public Health Road Map' of 
                the Centers for Disease Control and 
                Prevention;</DELETED>
                <DELETED>    ``(B) the manner in which the applicant 
                will coordinate with appropriate State and local 
                authorities as well as, in the case of a cooperative 
                agreement under paragraph (1)(B), relevant public and 
                private organizations or agencies; and</DELETED>
                <DELETED>    ``(C) the manner in which the applicant 
                will evaluate the effectiveness of any program carried 
                out under the cooperative agreement.</DELETED>
        <DELETED>    ``(4) Use of funds.--A health department awarded a 
        cooperative agreement under paragraph (1) shall use amounts 
        received under such cooperative agreement to--</DELETED>
                <DELETED>    ``(A) develop, implement, disseminate, 
                evaluate, and if applicable, expand programs to educate 
                individuals on matters related to Alzheimer's disease 
                described in paragraph (1)(A); and</DELETED>
                <DELETED>    ``(B) in the case of a cooperative 
                agreement under paragraph (1)(B), implement the most 
                current version of the `Healthy Brain Initiative: 
                Public Health Road Map' of the Centers for Disease 
                Control and Prevention and evaluate its 
                implementation.</DELETED>
        <DELETED>    ``(5) Matching requirement.--</DELETED>
                <DELETED>    ``(A) In general.--Except as may be 
                provided in subparagraph (B), each health department 
                that is awarded a cooperative agreement under paragraph 
                (1) shall provide, from non-Federal sources, an amount 
                equal to 15 percent of the amount provided under such 
                agreement (which may be provided in cash or in-kind) to 
                carry out the activities supported by the cooperative 
                agreement.</DELETED>
                <DELETED>    ``(B) Waiver authority.--The Secretary may 
                waive all or part of the matching requirement described 
                in subparagraph (A) for any fiscal year for--</DELETED>
                        <DELETED>    ``(i) a health department, if the 
                        Secretary determines that applying such 
                        matching requirement to the health department 
                        would result in serious hardship or an 
                        inability to carry out the purposes of the 
                        cooperative agreement awarded to such health 
                        department; or</DELETED>
                        <DELETED>    ``(ii) a rural or frontier 
                        region.</DELETED>
<DELETED>    ``(e) Cooperative Agreements for Analysis and Reporting of 
Data Regarding Cognitive Decline and Caregiving.--</DELETED>
        <DELETED>    ``(1) In general.--The Secretary may award 
        cooperative agreements to eligible entities for the following 
        activities:</DELETED>
                <DELETED>    ``(A) The analysis and timely public 
                reporting of data on the State and national levels 
                regarding cognitive decline, including Alzheimer's 
                disease, caregiving, and health disparities experienced 
                by individuals with cognitive decline and their 
                caregivers.</DELETED>
                <DELETED>    ``(B) The monitoring of objectives on 
                dementia, including Alzheimer's disease, and caregiving 
                in the program of the Secretary regarding health-status 
                goals for 2020 (commonly referred to as the `Healthy 
                People 2020 report'), and the development and 
                monitoring of such objectives in future Healthy People 
                reports of the Department of Health and Human 
                Services.</DELETED>
        <DELETED>    ``(2) Eligibility.--To be eligible to receive a 
        cooperative agreement under this subsection, an entity shall be 
        a public or nonprofit private entity, including institutions of 
        higher education, and submit to the Secretary an application at 
        such time, in such manner, and containing such information as 
        the Secretary may require.</DELETED>
        <DELETED>    ``(3) Surveillance.--The analysis, timely public 
        reporting, and dissemination of data regarding cognitive 
        decline, cognitive impairment, caregiving, and health 
        disparities on the State and national levels under a 
        cooperative agreement under this subsection may be carried out 
        by eligible entities using data sources such as the 
        following:</DELETED>
                <DELETED>    ``(A) The Behavioral Risk Factor 
                Surveillance System.</DELETED>
                <DELETED>    ``(B) The National Health and Nutrition 
                Examination Survey.</DELETED>
                <DELETED>    ``(C) The National Health Interview 
                Survey.</DELETED>
<DELETED>    ``(f) Data Collection.--The Secretary shall collect data 
on cognitive decline, cognitive impairment, caregiving, and health 
disparities on the State and national levels, using the surveillance 
systems described in subparagraphs (A) through (C) of subsection 
(e)(3).</DELETED>
<DELETED>    ``(g) Nonduplication of Effort.--The Secretary shall 
ensure that activities under any cooperative agreement awarded under 
this section do not unnecessarily duplicate efforts of other agencies 
and offices within the Department of Health and Human Services related 
to--</DELETED>
        <DELETED>    ``(1) activities of centers of excellence in 
        public health practice with respect to Alzheimer's disease 
        described in subsection (c);</DELETED>
        <DELETED>    ``(2) activities of public health departments with 
        respect to Alzheimer's disease described in subsection (d); 
        or</DELETED>
        <DELETED>    ``(3) the analysis and public reporting of 
        surveillance data on cognitive decline, caregiving, and health 
        disparities of individuals with Alzheimer's disease under 
        subsection (e).</DELETED>
<DELETED>    ``(h) Authorization of Appropriations.--For each of fiscal 
years 2018 through 2025, there are authorized to be appropriated 
$12,000,000 for purposes of carrying out subsection (c), $20,000,000 
for purposes of carrying out subsection (d), and $5,000,000 for 
purposes of carrying out subsections (e) and (f). Funds appropriated 
under this subsection shall remain available until 
expended.''.</DELETED>

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Building Our Largest Dementia 
Infrastructure for Alzheimer's Act'' or the ``BOLD Infrastructure for 
Alzheimer's Act''.

SEC. 2. PROMOTION OF PUBLIC HEALTH KNOWLEDGE AND AWARENESS OF 
              ALZHEIMER'S DISEASE, COGNITIVE DECLINE, AND BRAIN HEALTH 
              UNDER THE ALZHEIMER'S DISEASE AND HEALTHY AGING PROGRAM.

    Part K of title III of the Public Health Service Act (42 U.S.C. 
280c et seq.) is amended--
            (1) in the part heading, by adding ``and public health 
        programs for dementia'' at the end; and
            (2) in subpart II--
                    (A) by striking the subpart heading and inserting 
                the following:

``Subpart II--Programs With Respect to Alzheimer's Disease and Related 
                            Dementias''; and

                    (B) by striking section 398A (42 U.S.C. 280c-4) and 
                inserting the following:

``SEC. 398A. PROMOTION OF PUBLIC HEALTH KNOWLEDGE AND AWARENESS OF 
              ALZHEIMER'S DISEASE AND RELATED DEMENTIAS.

    ``(a) Alzheimer's Disease and Related Dementias Public Health 
Centers of Excellence.--
            ``(1) In general.--The Secretary, in coordination with the 
        Director of the Centers for Disease Control and Prevention and 
        the heads of other agencies as appropriate, shall award grants, 
        contracts, or cooperative agreements to eligible entities, such 
        as institutions of higher education, State, tribal, and local 
        health departments, Indian tribes, tribal organizations, 
        associations, or other appropriate entities for the 
        establishment or support of regional centers to address 
        Alzheimer's disease and related dementias by--
                    ``(A) advancing the awareness of public health 
                officials, health care professionals, and the public, 
                on the most current information and research related to 
                Alzheimer's disease and related dementias, including 
                cognitive decline, brain health, and associated health 
                disparities;
                    ``(B) identifying and translating promising 
                research findings, such as findings from research and 
                activities conducted or supported by the National 
                Institutes of Health, including Alzheimer's Disease 
                Research Centers authorized by section 445, into 
                evidence-based programmatic interventions for 
                populations with Alzheimer's disease and related 
                dementias and caregivers for such populations; and
                    ``(C) expanding activities, including through 
                public-private partnerships related to Alzheimer's 
                disease and related dementias and associated health 
                disparities.
            ``(2) Requirements.--To be eligible to receive a grant, 
        contract, or cooperative agreement under this subsection, an 
        entity shall submit to the Secretary an application containing 
        such agreements and information as the Secretary may require, 
        including a description of how the entity will--
                    ``(A) coordinate, as applicable, with existing 
                Federal, State, and tribal programs related to 
                Alzheimer's disease and related dementias;
                    ``(B) examine, evaluate, and promote evidence-based 
                interventions for individuals with Alzheimer's disease 
                and related dementias, including underserved 
                populations with such conditions, and those who provide 
                care for such individuals; and
                    ``(C) prioritize activities relating to--
                            ``(i) expanding efforts, as appropriate, to 
                        implement evidence-based practices to address 
                        Alzheimer's disease and related dementias, 
                        including through the training of State, local, 
                        and tribal public health officials and other 
                        health professionals on such practices;
                            ``(ii) supporting early detection and 
                        diagnosis of Alzheimer's disease and related 
                        dementias;
                            ``(iii) reducing the risk of potentially 
                        avoidable hospitalizations of individuals with 
                        Alzheimer's disease and related dementias;
                            ``(iv) reducing the risk of cognitive 
                        decline and cognitive impairment associated 
                        with Alzheimer's disease and related dementias;
                            ``(v) enhancing support to meet the needs 
                        of caregivers of individuals with Alzheimer's 
                        disease and related dementias;
                            ``(vi) reducing health disparities related 
                        to the care and support of individuals with 
                        Alzheimer's disease and related dementias;
                            ``(vii) supporting care planning and 
                        management for individuals with Alzheimer's 
                        disease and related dementias; and
                            ``(viii) supporting other relevant 
                        activities identified by the Secretary or the 
                        Director of the Centers for Disease Control and 
                        Prevention, as appropriate.
            ``(3) Considerations.--In awarding grants, contracts, and 
        cooperative agreements under this subsection, the Secretary 
        shall consider, among other factors, whether the entity--
                    ``(A) provides services to rural areas or other 
                underserved populations;
                    ``(B) is able to build on an existing 
                infrastructure of services and public health research; 
                and
                    ``(C) has experience with providing care or 
                caregiver support, or has experience conducting 
                research related to Alzheimer's disease and related 
                dementias.
            ``(4) Distribution of awards.--In awarding grants, 
        contracts, or cooperative agreements under this subsection, the 
        Secretary, to the extent practicable, shall ensure equitable 
        distribution of awards based on geographic area, including 
        consideration of rural areas, and the burden of the disease 
        within sub-populations.
            ``(5) Data reporting and program oversight.--With respect 
        to a grant, contract, or cooperative agreement awarded under 
        this subsection, not later than 90 days after the end of the 
        first year of the period of assistance, and annually thereafter 
        for the duration of the grant, contract, or agreement 
        (including the duration of any renewal period as provided for 
        under paragraph (5)), the entity shall submit data, as 
        appropriate, to the Secretary regarding--
                    ``(A) the programs and activities funded under the 
                grant, contract, or agreement; and
                    ``(B) outcomes related to such programs and 
                activities.
    ``(b) Improving Data on State and National Prevalence of 
Alzheimer's Disease and Related Dementias.--
            ``(1) In general.--The Secretary shall, as appropriate, 
        improve the analysis and timely reporting of data on the 
        incidence and prevalence of Alzheimer's disease and related 
        dementias. Such data may include, as appropriate, information 
        on cognitive decline, caregiving, and health disparities 
        experienced by individuals with cognitive decline and their 
        caregivers. The Secretary may award grants, contracts, or 
        cooperative agreements to eligible entities for activities 
        under this paragraph.
            ``(2) Eligibility.--To be eligible to receive a grant, 
        contract, or cooperative agreement under this subsection, an 
        entity shall be a public or nonprofit private entity, including 
        institutions of higher education, State, local, and tribal 
        health departments, and Indian tribes and tribal organizations, 
        and submit to the Secretary an application at such time, in 
        such manner, and containing such information as the Secretary 
        may require.
            ``(3) Data sources.--The analysis, timely public reporting, 
        and dissemination of data under this subsection may be carried 
        out using data sources such as the following:
                    ``(A) The Behavioral Risk Factor Surveillance 
                System.
                    ``(B) The National Health and Nutrition Examination 
                Survey.
                    ``(C) The National Health Interview Survey.
    ``(c) Improved Coordination.--The Secretary shall ensure that 
activities and programs related to dementia under this section do not 
unnecessarily duplicate activities and programs of other agencies and 
offices within the Department of Health and Human Services.''.

SEC. 3. SUPPORTING STATE PUBLIC HEALTH PROGRAMS RELATED TO ALZHEIMER'S 
              DISEASE AND RELATED DEMENTIAS.

    Section 398 of the Public Health Service Act (42 U.S.C. 280c-3) is 
amended--
            (1) in the section heading, by striking ``establishment of 
        program'' and inserting ``cooperative agreements to states and 
        public health departments for alzheimer's disease and related 
        dementias'';
            (2) by striking subsection (a) and inserting the following:
    ``(a) In General.--The Secretary, in coordination with the Director 
of the Centers for Disease Control and Prevention and the heads of 
other agencies, as appropriate, shall award cooperative agreements to 
health departments of States, political subdivisions of States, and 
Indian tribes and tribal organizations, to address Alzheimer's disease 
and related dementias, including by reducing cognitive decline, helping 
meet the needs of caregivers, and addressing unique aspects of 
Alzheimer's disease and related dementias to support the development 
and implementation of evidence-based interventions with respect to--
            ``(1) educating and informing the public, based on 
        evidence-based public health research and data, about 
        Alzheimer's disease and related dementias;
            ``(2) supporting early detection and diagnosis;
            ``(3) reducing the risk of potentially avoidable 
        hospitalizations for individuals with Alzheimer's disease and 
        related dementias;
            ``(4) reducing the risk of cognitive decline and cognitive 
        impairment associated with Alzheimer's disease and related 
        dementias;
            ``(5) improving support to meet the needs of caregivers of 
        individuals with Alzheimer's disease and related dementias;
            ``(6) supporting care planning and management for 
        individuals with Alzheimer's disease and related dementias.
            ``(7) supporting other relevant activities identified by 
        the Secretary or the Director of the Centers for Disease 
        Control and Prevention, as appropriate''.; and
            (3) by striking subsection (b);
            (4) by redesignating subsection (c) as subsection (g);
            (5) by inserting after subsection (a), the following:
    ``(b) Preference.--In awarding cooperative agreements under this 
section, the Secretary shall give preference to applications that focus 
on addressing health disparities, including populations and geographic 
areas that have the highest prevalence of Alzheimer's disease and 
related dementias.
    ``(c) Eligibility.--To be eligible to receive a cooperative 
agreement under this section, an eligible entity (pursuant to 
subsection (a)) shall prepare and submit to the Secretary an 
application at such time, in such manner, and containing such 
information as the Secretary may require, including a plan that 
describes--
            ``(1) how the applicant proposes to develop or expand, 
        programs to educate individuals through partnership engagement, 
        workforce development, guidance and support for programmatic 
        efforts, and evaluation with respect to Alzheimer's disease and 
        related dementias, and in the case of a cooperative agreement 
        under this section, how the applicant proposes to support other 
        relevant activities identified by the Secretary or Director of 
        the Centers for Disease Control and Prevention, as appropriate.
            ``(2) the manner in which the applicant will coordinate 
        with Federal, tribal, and State programs related to Alzheimer's 
        disease and related dementias, and appropriate State, tribal, 
        and local agencies, as well as other relevant public and 
        private organizations or agencies; and
            ``(3) the manner in which the applicant will evaluate the 
        effectiveness of any program carried out under the cooperative 
        agreement.
    ``(d) Matching Requirement.--Each health department that is awarded 
a cooperative agreement under subsection (a) shall provide, from non-
Federal sources, an amount equal to 30 percent of the amount provided 
under such agreement (which may be provided in cash or in-kind) to 
carry out the activities supported by the cooperative agreement.
    ``(e) Waiver Authority.--The Secretary may waive all or part of the 
matching requirement described in subsection (d) for any fiscal year 
for--
            ``(1) a health department of a State, political subdivision 
        of a State, or Indian tribe and tribal organization, if the 
        Secretary determines that applying such matching requirement 
        would result in serious hardship or an inability to carry out 
        the purposes of the cooperative agreement awarded to such 
        health department of a State, political subdivision of a State, 
        or Indian tribe and tribal organization; or
            ``(2) a health department of a State, political subdivision 
        of a State, or Indian tribe and tribal organization located in 
        a rural area or frontier area.'';
            (6) in subsection (f) (as so redesignated), by striking 
        ``grant'' and inserting ``cooperative agreement''; and
            (7) by adding at the end the following:
    ``(f) Non-duplication of Effort.--The Secretary shall ensure that 
activities under any cooperative agreement awarded under this subpart 
do not unnecessarily duplicate efforts of other agencies and offices 
within the Department of Health and Human Services related to--
            ``(1) activities of centers of excellence with respect to 
        Alzheimer's disease and related dementias described in section 
        398A; and
            ``(2) activities of public health departments with respect 
        to Alzheimer's disease and related dementias described in this 
        section.''.

SEC. 4. ADDITIONAL PROVISIONS.

    Section 398B of the Public Health Service Act (42 U.S.C. 280c-5) is 
amended--
            (1) in subsection (a)--
                    (A) by inserting ``or cooperative agreement'' after 
                ``grant'' each place that such appears;
                    (B) by striking ``section 398(a) to a State unless 
                the State'' and inserting ``sections 398 or 398A to an 
                entity unless the entity''; and
                    (C) by striking ``10'' and inserting ``5'';
            (2) by striking subsection (b);
            (3) by redesignating subsections (c) and (d) as subsections 
        (b) and (c), respectively;
            (4) in subsection (b) (as so redesignated)--
                    (A) in the matter preceding paragraph (1), by 
                striking ``section 398(a) to a State unless the State'' 
                and inserting ``sections 398 or 398A to an entity 
                unless the entity'';
                    (B) in paragraph (1), by striking ``expenditures 
                required in subsection (b);'' and inserting 
                ``expenditures;'';
            (5) in subsection (c) (as so redesignated)--
                    (A) in paragraph (1)--
                            (i) by striking ``each demonstration 
                        project for which a grant'' and inserting ``the 
                        activities for which an award''; and
                            (ii) by striking ``section 398(a)'' and 
                        inserting ``sections 398 or 398A''; and
                    (B) in paragraph (2), by striking ``6 months'' and 
                inserting ``1 year'';
            (6) by inserting after subsection (c) (as so redesignated), 
        the following:
    ``(d) Definition.--In this subpart, the terms `Indian tribe' and 
`tribal organization' have the meanings given such terms in section 4 
of the Indian Health Care Improvement Act.''; and
            (7) in subsection (e), by striking ``$5,000,000 for each of 
        the fiscal years 1988 through 1990'' and all that follows 
        through ``2002'' and inserting ``$20,000,000 for each of fiscal 
        years 2020 through 2024''.
                                                       Calendar No. 694

115th CONGRESS

  2d Session

                                S. 2076

_______________________________________________________________________

                                 A BILL

 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.

_______________________________________________________________________

                           November 29, 2018

                       Reported with an amendment
```