S. 2076 

One Hundred Fifteenth Congress 

of the 

United States of America 

AT THE SECOND SESSION 

Begun and held at the City of Washington on Wednesday, 

the third day of January, two thousand and eighteen 

An Act 

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, 

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— 
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‘‘(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— 
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‘‘(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.’’. 
S. 2076—4 

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 evidencebased 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. 
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‘‘(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 a health department of a State, political subdivision 

of a State, or Indian tribe and tribal organization (including those 

located in a rural area or frontier area), 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.’’; 

(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;’’; 
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(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’’. 

Speaker of the House of Representatives. 

Vice President of the United States and

President of the Senate.