I 

111TH CONGRESS 

2D SESSION H. R. 5926 

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

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

living with Alzheimer’s disease by increasing detection, diagnosis, care, 

and planning. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 29, 2010 

Mr. MARKEY of Massachusetts (for himself, Mr. SMITH of New Jersey, Mr. 

KLEIN of Florida, and Mr. GARAMENDI) introduced the following bill; 

which was referred to the Committee on Energy and Commerce, and in 

addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such 

provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to provide 

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

to improve care and outcomes for Americans living with 

Alzheimer’s disease by increasing detection, diagnosis, 

care, and planning. 

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


srobinson on DSKHWCL6B1PROD with BILLS
2 

•HR 5926 IH

1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘HOPE for Alzheimer’s: 

3 Health Outcomes, Planning, and Education Act’’. 

4 SEC. 2. MEDICARE COVERAGE OF COMPREHENSIVE ALZ5 HEIMER’S DISEASE AND OTHER DEMENTIA 

6 DIAGNOSIS AND SERVICES. 

7 (a) IN GENERAL.—Section 1861 of the Social Secu8 rity Act is amended— 

9 (1) in subsection (s)(2)— 

10 (A) by striking ‘‘and’’ at the end of sub11 paragraph (EE); 

12 (B) by adding ‘‘and’’ at the end of sub13 paragraph (FF); and 

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

15 subparagraph: 

16 ‘‘(GG) comprehensive Alzheimer’s disease and 

17 other dementia diagnosis and services (as defined in 

18 subsection (iii));’’; and 

19 (2) by adding at the end the following new sub20 section: 

21 ‘‘Comprehensive Alzheimer’s Disease and Other 

22 Dementia Diagnosis and Services 

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

24 and other dementia diagnosis and services’ means the 

25 services described in paragraph (2) furnished to an indi26 vidual— 


srobinson on DSKHWCL6B1PROD with BILLS
3 

•HR 5926 IH

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

2 Alzheimer’s disease or other dementia; and 

3 ‘‘(B) for whom there has been a determination 

4 by a physician or practitioner (as defined in section 

5 1842(b)(18)(C)), in a medical setting such as a phy6 sician’s office, a skilled nursing facility, a community 

7 health center, or another similar setting, that the in8 dividual— 

9 ‘‘(i) may have a cognitive impairment or 

10 dementia; and 

11 ‘‘(ii) has a need for a diagnostic evaluation 

12 for Alzheimer’s disease or another dementia. 

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

14 following: 

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

16 to a specialist if recommended, in accordance with 

17 guidelines specified by the Secretary. 

18 ‘‘(B) If the individual is diagnosed with Alz19 heimer’s disease or another dementia under the eval20 uation under subparagraph (A), care planning serv21 ices (with the individual or with one or more family 

22 caregivers of the individual without the presence of 

23 the individual), including assistance understanding 

24 the diagnosis as well as the medical and non-medical 

25 options for ongoing treatment, services, and supVerDate Mar 15 2010 22:23 Jul 30, 2010 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H5926.IH H5926

srobinson on DSKHWCL6B1PROD with BILLS
4 

•HR 5926 IH

1 ports, and information about how to obtain such 

2 treatments, services, and supports. 

3 ‘‘(C) Medical record documentation, with re4 spect to an individual, of the diagnostic evaluation 

5 under subparagraph (A) and any care planning serv6 ices under subparagraph (B). 

7 ‘‘(3) The Secretary shall establish standards to carry 

8 out this subsection in consultation with Alzheimer’s dis9 ease and other dementia stakeholders, including patients 

10 and their advocates, and medical experts in the areas of 

11 detection, diagnostics, and care planning.’’. 

12 (b) PAYMENT.—Section 1833(a)(1) of the Social Se13 curity Act (42 U.S.C. 1395l(a)(1)) is amended by striking 

14 ‘‘and’’ before ‘‘(X)’’ and inserting before the semicolon at 

15 the end the following: ‘‘, and (Y) with respect to com16 prehensive Alzheimer’s disease and other dementia diag17 nosis and services (as defined in section 1861(iii)), the 

18 amount paid shall be an amount equal to 80 percent of 

19 the amount determined under a fee schedule established 

20 by the Secretary’’. 

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

22 this section shall apply to services furnished on or after 

23 January 1, 2011. 


srobinson on DSKHWCL6B1PROD with BILLS
5 

•HR 5926 IH

1 SEC. 3. FEDERAL COORDINATED HEALTH CARE OFFICE 

2 STUDY AND REPORT. 

3 (a) STUDY.—The Federal Coordinated Health Care 

4 Office (as established under section 2602 of the Patient 

5 Protection and Affordable Care Act (42 U.S.C. 1315b)) 

6 shall conduct a study to identify— 

7 (1) barriers to the detection of Alzheimer’s dis8 ease and other dementias for dual eligible individuals 

9 (as defined in subsection (f) of such section 2602); 

10 (2) barriers to the furnishing of comprehensive 

11 Alzheimer’s disease and other dementia diagnosis 

12 and services (as defined in section 1866(iii) of the 

13 Social Security Act, as added by section 2) to such 

14 individuals; and 

15 (3) ways to eliminate the barriers described in 

16 paragraphs (1) and (2). 

17 (b) REPORT.—Not later than 2 years after the date 

18 of the enactment of this Act, the Federal Coordinated 

19 Health Care Office shall submit to Congress a report on 

20 the study conducted under subsection (a) together with 

21 recommendations for such legislation and administrative 

22 actions as the Office determines appropriate. 

Æ 


srobinson on DSKHWCL6B1PROD with BILLS