I 

113TH CONGRESS 

1ST SESSION H. R. 1507 

To amend title XVIII of the Social Security Act to increase diagnosis of 

Alzheimer’s disease and related dementias, leading to better care and 

outcomes for Americans living with Alzheimer’s disease and related dementias. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 11, 2013 

Mr. MARKEY (for himself, Mr. SMITH of New Jersey, Mr. BURGESS, Mrs. 

CAPITO, Ms. SPEIER, Mr. JOHNSON of Georgia, Ms. TSONGAS, Ms. NORTON, Mr. FATTAH, Ms. MOORE, Mrs. CAROLYN B. MALONEY of New 

York, Mr. RUNYAN, Mr. SCHIFF, Mr. ROSKAM, Mr. GARAMENDI, Mr. 

TIERNEY, Mr. ISRAEL, and Ms. EDDIE BERNICE JOHNSON of Texas) 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 increase 

diagnosis of Alzheimer’s disease and related dementias, 

leading to better care and outcomes for Americans living 

with Alzheimer’s disease and related dementias. 

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 ‘‘Health Outcomes, 

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

4 SEC. 2. FINDINGS AND PURPOSE. 

5 (a) FINDINGS.—Congress makes the following find6 ings: 

7 (1) As many as half of the estimated 5.2 mil8 lion Americans with Alzheimer’s disease have never 

9 received a diagnosis. 

10 (2) An early and documented diagnosis and ac11 cess to care planning services leads to better out12 comes for individuals with Alzheimer’s disease and 

13 other dementias and their caregivers. 

14 (3) Combining the existing Medicare benefits of 

15 a diagnostic evaluation and care planning into a sin16 gle package of services would help ensure that indi17 viduals receive an appropriate diagnosis as well as 

18 critical information about the disease and available 

19 care options, which leads to better outcomes. 

20 (4) An accurate diagnosis allows for better 

21 management of other known chronic conditions and 

22 more efficient utilization of medical resources, in23 cluding reducing complications and the number of 

24 costly emergency room visits and hospitalizations. 

25 (5) A formal diagnosis allows individuals and 

26 their caregivers to have access to available medical 


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1 and non-medical treatments, build a care team, par2 ticipate in support services, and enroll in clinical 

3 trials. 

4 (6) Undertaking the diagnostic process poten5 tially allows cognitive impairment to be reversed, as 

6 the cognitive impairment of nine percent of individ7 uals experiencing dementia-like symptoms is due to 

8 a potentially reversible cause, such as depression or 

9 vitamin deficiency. 

10 (b) PURPOSE.—The purpose of this Act is to increase 

11 diagnosis of Alzheimer’s disease and related dementias, 

12 leading to better care and outcomes for Americans living 

13 with Alzheimer’s disease and related dementias. 

14 SEC. 3. MEDICARE COVERAGE OF COMPREHENSIVE ALZ15 HEIMER’S DISEASE DIAGNOSIS AND SERV16 ICES. 

17 (a) IN GENERAL.—Section 1861 of the Social Secu18 rity Act (42 U.S.C. 1395x) is amended— 

19 (1) in subsection (s)(2)— 

20 (A) by striking ‘‘and’’ at the end of sub21 paragraph (EE); 

22 (B) by adding ‘‘and’’ at the end of sub23 paragraph (FF); and 

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

25 subparagraph: 


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1 ‘‘(GG) comprehensive Alzheimer’s disease diag2 nosis and services (as defined in subsection (iii));’’; 

3 and 

4 (2) by adding at the end the following new sub5 section: 

6 ‘‘Comprehensive Alzheimer’s Disease Diagnosis and 

7 Services 

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

9 diagnosis and services’ means the services described in 

10 paragraph (2) furnished to an individual— 

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

12 Alzheimer’s disease; and 

13 ‘‘(B) for whom a physician or a practitioner de14 scribed in clause (i), (iv), or (v) of section 

15 1842(b)(18)(C), in a medical setting such as a phy16 sician’s office, a hospital, a skilled nursing facility, 

17 a community health center, or another similar med18 ical setting— 

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

20 a cognitive impairment or dementia; and 

21 ‘‘(ii) pursuant to such detection, has deter22 mined a diagnostic evaluation for Alzheimer’s 

23 disease is needed. 

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

25 following: 


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

2 to a specialist if recommended. 

3 ‘‘(B) If the individual is diagnosed with Alz4 heimer’s disease under the diagnostic evaluation 

5 under subparagraph (A), care planning services 

6 (with the individual, with the personal representative 

7 of the individual, or with one or more family care8 givers of the individual with or without the presence 

9 of the individual), including assistance under10 standing the diagnosis as well as the medical and 

11 non-medical options for ongoing treatment, services, 

12 and supports, and information about how to obtain 

13 such treatments, services, and supports. Such care 

14 planning services for individuals diagnosed with Alz15 heimer’s disease should take into consideration and 

16 address other co-morbid chronic conditions. 

17 ‘‘(C) Medical record documentation, with re18 spect to an individual, of the diagnostic evaluation 

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

20 planning services under subparagraph (B). 

21 ‘‘(3) In this subsection— 

22 ‘‘(A) the term ‘Alzheimer’s disease’ means Alz23 heimer’s disease and related dementias; and 

24 ‘‘(B) the term ‘personal representative’ means, 

25 with respect to an individual, a person legally auVerDate Mar 15 2010 23:57 Apr 18, 2013 Jkt 029200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1507.IH H1507

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1 thorized to make health care decisions on such indi2 vidual’s behalf.’’. 

3 (b) PAYMENT.—Section 1833(a)(1) of the Social Se4 curity Act (42 U.S.C. 1395l(a)(1)) is amended by striking 

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

6 the end the following: ‘‘, and (AA) with respect to com7 prehensive Alzheimer’s disease diagnosis and services (as 

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

9 amount equal to 80 percent of the amount determined 

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

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

12 this section shall apply to services furnished on or after 

13 January 1 of the year following the year which includes 

14 the date of the enactment of this Act. 

Æ 


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