II 

112TH CONGRESS 

1ST SESSION S. 738 

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

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

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

IN THE SENATE OF THE UNITED STATES 

APRIL 6 (legislative day, APRIL 5), 2011 

Ms. STABENOW (for herself and Ms. COLLINS) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to provide 

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

to improve care and outcomes for Americans living with 

Alzheimer’s disease and related dementias by improving 

detection, diagnosis, and care planning. 

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

3 SECTION 1. SHORT TITLE. 

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

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


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1 SEC. 2. MEDICARE COVERAGE OF COMPREHENSIVE ALZ2 HEIMER’S DISEASE DIAGNOSIS AND SERV3 ICES. 

4 (a) IN GENERAL.—Section 1861 of the Social Secu5 rity Act is amended— 

6 (1) in subsection (s)(2)— 

7 (A) by striking ‘‘and’’ at the end of sub8 paragraph (EE); 

9 (B) by adding ‘‘and’’ at the end of sub10 paragraph (FF); and 

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

12 subparagraph: 

13 ‘‘(GG) comprehensive Alzheimer’s disease diag14 nosis and services (as defined in subsection (iii));’’; 

15 and 

16 (2) by adding at the end the following new sub17 section: 

18 ‘‘Comprehensive Alzheimer’s Disease Diagnosis and 

19 Services 

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

21 diagnosis and services’ means the services described in 

22 paragraph (2) furnished to an individual— 

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

24 Alzheimer’s disease; and 

25 ‘‘(B) for whom a physician or a practitioner de26 scribed in clause (i), (iv), or (v) of section 


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1 1842(b)(18)(C), in a medical setting such as a phy2 sician’s office, a hospital, a skilled nursing facility, 

3 a community health center, or another similar med4 ical setting— 

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

6 a cognitive impairment or dementia; and 

7 ‘‘(ii) pursuant to such detection, has deter8 mined a diagnostic evaluation for Alzheimer’s 

9 disease is needed. 

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

11 following: 

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

13 to a specialist if recommended. 

14 ‘‘(B) If the individual is diagnosed with Alz15 heimer’s disease under the diagnostic evaluation 

16 under subparagraph (A), care planning services 

17 (with the individual or with one or more family care18 givers of the individual without the presence of the 

19 individual), including assistance understanding the 

20 diagnosis as well as the medical and non-medical op21 tions for ongoing treatment, services, and supports, 

22 and information about how to obtain such treat23 ments, services, and supports. 

24 ‘‘(C) Medical record documentation, with re25 spect to an individual, of the diagnostic evaluation 


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

2 planning services under subparagraph (B). 

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

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

5 (b) PAYMENT.—Section 1833(a)(1) of the Social Se6 curity Act (42 U.S.C. 1395l(a)(1)) is amended by striking 

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

8 the end the following: ‘‘, and (AA) with respect to com9 prehensive Alzheimer’s disease diagnosis and services (as 

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

11 amount equal to 80 percent of the amount determined 

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

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

14 this section shall apply to services furnished on or after 

15 January 1 of the year following the year which includes 

16 the date of the enactment of this Act. 

Æ 


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