115TH CONGRESS 

2D SESSION S. 2076 

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. 

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

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

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

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

5 SEC. 2. PROMOTION OF PUBLIC HEALTH KNOWLEDGE AND 

6 AWARENESS OF ALZHEIMER’S DISEASE, COG7 NITIVE DECLINE, AND BRAIN HEALTH UNDER 

8 THE ALZHEIMER’S DISEASE AND HEALTHY 

9 AGING PROGRAM. 

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

11 (42 U.S.C. 280c et seq.) is amended— 

12 (1) in the part heading, by adding ‘‘AND PUB13 LIC HEALTH PROGRAMS FOR DEMENTIA’’ at the 

14 end; and 

15 (2) in subpart II— 

16 (A) by striking the subpart heading and 

17 inserting the following: 

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

19 Disease and Related Dementias’’; and 

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

21 280c–4) and inserting the following: 

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

23 AND AWARENESS OF ALZHEIMER’S DISEASE 

24 AND RELATED DEMENTIAS. 

25 ‘‘(a) ALZHEIMER’S DISEASE AND RELATED DEMEN26 TIAS PUBLIC HEALTH CENTERS OF EXCELLENCE.— 
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1 ‘‘(1) IN GENERAL.—The Secretary, in coordina2 tion with the Director of the Centers for Disease 

3 Control and Prevention and the heads of other agen4 cies as appropriate, shall award grants, contracts, or 

5 cooperative agreements to eligible entities, such as 

6 institutions of higher education, State, tribal, and 

7 local health departments, Indian tribes, tribal orga8 nizations, associations, or other appropriate entities 

9 for the establishment or support of regional centers 

10 to address Alzheimer’s disease and related dementias 

11 by— 

12 ‘‘(A) advancing the awareness of public 

13 health officials, health care professionals, and 

14 the public, on the most current information and 

15 research related to Alzheimer’s disease and re16 lated dementias, including cognitive decline, 

17 brain health, and associated health disparities; 

18 ‘‘(B) identifying and translating promising 

19 research findings, such as findings from re20 search and activities conducted or supported by 

21 the National Institutes of Health, including Alz22 heimer’s Disease Research Centers authorized 

23 by section 445, into evidence-based pro24 grammatic interventions for populations with 
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1 Alzheimer’s disease and related dementias and 

2 caregivers for such populations; and 

3 ‘‘(C) expanding activities, including 

4 through public-private partnerships related to 

5 Alzheimer’s disease and related dementias and 

6 associated health disparities. 

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

8 a grant, contract, or cooperative agreement under 

9 this subsection, an entity shall submit to the Sec10 retary an application containing such agreements 

11 and information as the Secretary may require, in12 cluding a description of how the entity will— 

13 ‘‘(A) coordinate, as applicable, with exist14 ing Federal, State, and tribal programs related 

15 to Alzheimer’s disease and related dementias; 

16 ‘‘(B) examine, evaluate, and promote evi17 dence-based interventions for individuals with 

18 Alzheimer’s disease and related dementias, in19 cluding underserved populations with such con20 ditions, and those who provide care for such in21 dividuals; and 

22 ‘‘(C) prioritize activities relating to— 

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

24 to implement evidence-based practices to 

25 address Alzheimer’s disease and related de-
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1 mentias, including through the training of 

2 State, local, and tribal public health offi3 cials and other health professionals on 

4 such practices; 

5 ‘‘(ii) supporting early detection and 

6 diagnosis of Alzheimer’s disease and re7 lated dementias; 

8 ‘‘(iii) reducing the risk of potentially 

9 avoidable hospitalizations of individuals 

10 with Alzheimer’s disease and related de11 mentias; 

12 ‘‘(iv) reducing the risk of cognitive de13 cline and cognitive impairment associated 

14 with Alzheimer’s disease and related de15 mentias; 

16 ‘‘(v) enhancing support to meet the 

17 needs of caregivers of individuals with Alz18 heimer’s disease and related dementias; 

19 ‘‘(vi) reducing health disparities re20 lated to the care and support of individuals 

21 with Alzheimer’s disease and related de22 mentias; 

23 ‘‘(vii) supporting care planning and 

24 management for individuals with Alz-
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1 heimer’s disease and related dementias; 

2 and 

3 ‘‘(viii) supporting other relevant ac4 tivities identified by the Secretary or the 

5 Director of the Centers for Disease Control 

6 and Prevention, as appropriate. 

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

8 contracts, and cooperative agreements under this 

9 subsection, the Secretary shall consider, among 

10 other factors, whether the entity— 

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

12 other underserved populations; 

13 ‘‘(B) is able to build on an existing infra14 structure of services and public health research; 

15 and 

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

17 caregiver support, or has experience conducting 

18 research related to Alzheimer’s disease and re19 lated dementias. 

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

21 grants, contracts, or cooperative agreements under 

22 this subsection, the Secretary, to the extent prac23 ticable, shall ensure equitable distribution of awards 

24 based on geographic area, including consideration of 
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1 rural areas, and the burden of the disease within 

2 sub-populations. 

3 ‘‘(5) DATA REPORTING AND PROGRAM OVER4 SIGHT.—With respect to a grant, contract, or coop5 erative agreement awarded under this subsection, 

6 not later than 90 days after the end of the first year 

7 of the period of assistance, and annually thereafter 

8 for the duration of the grant, contract, or agreement 

9 (including the duration of any renewal period as pro10 vided for under paragraph (5)), the entity shall sub11 mit data, as appropriate, to the Secretary regard12 ing— 

13 ‘‘(A) the programs and activities funded 

14 under the grant, contract, or agreement; and 

15 ‘‘(B) outcomes related to such programs 

16 and activities. 

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

18 PREVALENCE OF ALZHEIMER’S DISEASE AND RELATED

19 DEMENTIAS.— 

20 ‘‘(1) IN GENERAL.—The Secretary shall, as ap21 propriate, improve the analysis and timely reporting 

22 of data on the incidence and prevalence of Alz23 heimer’s disease and related dementias. Such data 

24 may include, as appropriate, information on cog25 nitive decline, caregiving, and health disparities ex-
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1 perienced by individuals with cognitive decline and 

2 their caregivers. The Secretary may award grants, 

3 contracts, or cooperative agreements to eligible enti4 ties for activities under this paragraph. 

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

6 grant, contract, or cooperative agreement under this 

7 subsection, an entity shall be a public or nonprofit 

8 private entity, including institutions of higher edu9 cation, State, local, and tribal health departments, 

10 and Indian tribes and tribal organizations, and sub11 mit to the Secretary an application at such time, in 

12 such manner, and containing such information as 

13 the Secretary may require. 

14 ‘‘(3) DATA SOURCES.—The analysis, timely 

15 public reporting, and dissemination of data under 

16 this subsection may be carried out using data 

17 sources such as the following: 

18 ‘‘(A) The Behavioral Risk Factor Surveil19 lance System. 

20 ‘‘(B) The National Health and Nutrition 

21 Examination Survey. 

22 ‘‘(C) The National Health Interview Sur23 vey. 

24 ‘‘(c) IMPROVED COORDINATION.—The Secretary 

25 shall ensure that activities and programs related to de-
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1 mentia under this section do not unnecessarily duplicate 

2 activities and programs of other agencies and offices with3 in the Department of Health and Human Services.’’. 

4 SEC. 3. SUPPORTING STATE PUBLIC HEALTH PROGRAMS 

5 RELATED TO ALZHEIMER’S DISEASE AND RE6 LATED DEMENTIAS. 

7 Section 398 of the Public Health Service Act (42 

8 U.S.C. 280c–3) is amended— 

9 (1) in the section heading, by striking ‘‘ESTAB10 LISHMENT OF PROGRAM’’ and inserting ‘‘COOP11 ERATIVE AGREEMENTS TO STATES AND PUB12 LIC HEALTH DEPARTMENTS FOR ALZHEIMER’S

13 DISEASE AND RELATED DEMENTIAS’’; 

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

15 following: 

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

17 with the Director of the Centers for Disease Control and 

18 Prevention and the heads of other agencies, as appro19 priate, shall award cooperative agreements to health de20 partments of States, political subdivisions of States, and 

21 Indian tribes and tribal organizations, to address Alz22 heimer’s disease and related dementias, including by re23 ducing cognitive decline, helping meet the needs of care24 givers, and addressing unique aspects of Alzheimer’s dis25 ease and related dementias to support the development 
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1 and implementation of evidence-based interventions with 

2 respect to— 

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

4 on evidence-based public health research and data, 

5 about Alzheimer’s disease and related dementias; 

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

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

8 hospitalizations for individuals with Alzheimer’s dis9 ease and related dementias; 

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

11 cognitive impairment associated with Alzheimer’s 

12 disease and related dementias; 

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

14 caregivers of individuals with Alzheimer’s disease 

15 and related dementias; 

16 ‘‘(6) supporting care planning and management 

17 for individuals with Alzheimer’s disease and related 

18 dementias. 

19 ‘‘(7) supporting other relevant activities identi20 fied by the Secretary or the Director of the Centers 

21 for Disease Control and Prevention, as appro22 priate’’.; and 

23 (3) by striking subsection (b); 

24 (4) by redesignating subsection (c) as sub25 section (g); 
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1 (5) by inserting after subsection (a), the fol2 lowing: 

3 ‘‘(b) PREFERENCE.—In awarding cooperative agree4 ments under this section, the Secretary shall give pref5 erence to applications that focus on addressing health dis6 parities, including populations and geographic areas that 

7 have the highest prevalence of Alzheimer’s disease and re8 lated dementias. 

9 ‘‘(c) ELIGIBILITY.—To be eligible to receive a cooper10 ative agreement under this section, an eligible entity (pur11 suant to subsection (a)) shall prepare and submit to the 

12 Secretary an application at such time, in such manner, 

13 and containing such information as the Secretary may re14 quire, including a plan that describes— 

15 ‘‘(1) how the applicant proposes to develop or 

16 expand, programs to educate individuals through 

17 partnership engagement, workforce development, 

18 guidance and support for programmatic efforts, and 

19 evaluation with respect to Alzheimer’s disease and 

20 related dementias, and in the case of a cooperative 

21 agreement under this section, how the applicant pro22 poses to support other relevant activities identified 

23 by the Secretary or Director of the Centers for Dis24 ease Control and Prevention, as appropriate. 
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1 ‘‘(2) the manner in which the applicant will co2 ordinate with Federal, tribal, and State programs 

3 related to Alzheimer’s disease and related dementias, 

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

5 well as other relevant public and private organiza6 tions or agencies; and 

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

8 evaluate the effectiveness of any program carried out 

9 under the cooperative agreement. 

10 ‘‘(d) MATCHING REQUIREMENT.—Each health de11 partment that is awarded a cooperative agreement under 

12 subsection (a) shall provide, from non-Federal sources, an 

13 amount equal to 30 percent of the amount provided under 

14 such agreement (which may be provided in cash or in15 kind) to carry out the activities supported by the coopera16 tive agreement. 

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

18 all or part of the matching requirement described in sub19 section (d) for any fiscal year for a health department of 

20 a State, political subdivision of a State, or Indian tribe 

21 and tribal organization (including those located in a rural 

22 area or frontier area), if the Secretary determines that ap23 plying such matching requirement would result in serious 

24 hardship or an inability to carry out the purposes of the 

25 cooperative agreement awarded to such health department 
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1 of a State, political subdivision of a State, or Indian tribe 

2 and tribal organization.’’; 

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

4 striking ‘‘grant’’ and inserting ‘‘cooperative agree5 ment’’; and 

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

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

8 shall ensure that activities under any cooperative agree9 ment awarded under this subpart do not unnecessarily du10 plicate efforts of other agencies and offices within the De11 partment of Health and Human Services related to— 

12 ‘‘(1) activities of centers of excellence with re13 spect to Alzheimer’s disease and related dementias 

14 described in section 398A; and 

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

16 respect to Alzheimer’s disease and related dementias 

17 described in this section.’’. 

18 SEC. 4. ADDITIONAL PROVISIONS. 

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

20 U.S.C. 280c–5) is amended— 

21 (1) in subsection (a)— 

22 (A) by inserting ‘‘or cooperative agree23 ment’’ after ‘‘grant’’ each place that such ap24 pears; 
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1 (B) by striking ‘‘section 398(a) to a State 

2 unless the State’’ and inserting ‘‘sections 398 

3 or 398A to an entity unless the entity’’; and 

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

5 (2) by striking subsection (b); 

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

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

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

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

10 by striking ‘‘section 398(a) to a State unless 

11 the State’’ and inserting ‘‘sections 398 or 398A 

12 to an entity unless the entity’’; 

13 (B) in paragraph (1), by striking ‘‘expendi14 tures required in subsection (b);’’ and inserting 

15 ‘‘expenditures;’’; 

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

17 (A) in paragraph (1)— 

18 (i) by striking ‘‘each demonstration 

19 project for which a grant’’ and inserting 

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

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

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

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

24 months’’ and inserting ‘‘1 year’’; 
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1 (6) by inserting after subsection (c) (as so re2 designated), the following: 

3 ‘‘(d) DEFINITION.—In this subpart, the terms ‘In4 dian tribe’ and ‘tribal organization’ have the meanings 

5 given such terms in section 4 of the Indian Health Care 

6 Improvement Act.’’; and 

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

8 for each of the fiscal years 1988 through 1990’’ and 

9 all that follows through ‘‘2002’’ and inserting 

10 ‘‘$20,000,000 for each of fiscal years 2020 through 

11 2024’’. 

Passed the Senate December 12, 2018. 

Attest: 

Secretary. 
115TH CONGRESS 

2D SESSION S. 2076 

AN ACT 

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 Alz-