II 

114TH CONGRESS 

1ST SESSION S. 857 

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

under the Medicare program of an initial comprehensive care plan for 

Medicare beneficiaries newly diagnosed with Alzheimer’s disease and related dementias, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 25, 2015 

Ms. STABENOW (for herself, Ms. COLLINS, Mr. MARKEY, and Mrs. CAPITO) 

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 coverage under the Medicare program of an initial 

comprehensive care plan for Medicare beneficiaries newly 

diagnosed with Alzheimer’s disease and related dementias, 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, 

3 SECTION 1. SHORT TITLE. 

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

5 Planning, and Education (HOPE) for Alzheimer’s Act of 

6 2015’’. 


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1 SEC. 2. FINDINGS AND PURPOSE. 

2 (a) FINDINGS.—Congress makes the following find3 ings: 

4 (1) As many as half of the estimated 5,100,000 

5 American seniors with Alzheimer’s disease and other 

6 dementias have never received a diagnosis. 

7 (2) An early and documented diagnosis and ac8 cess to care planning services leads to better out9 comes for individuals with Alzheimer’s disease and 

10 other dementias and their caregivers. 

11 (3) Building upon the existing Medicare benefit 

12 of a diagnostic evaluation to add comprehensive care 

13 planning services would help ensure that bene14 ficiaries and their families receive critical informa15 tion about the disease and available care options, 

16 which leads to better outcomes. 

17 (4) An accurate, timely, and documented diag18 nosis allows for better management of other known 

19 chronic conditions and more efficient utilization of 

20 medical resources, including reducing complications 

21 and the number of costly emergency room visits and 

22 hospitalizations. 

23 (5) A formal and documented diagnosis and 

24 care planning services allow individuals and their 

25 caregivers to have access to available medical and 


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1 non-medical treatments, build a care team, partici2 pate in support services, and enroll in clinical trials. 

3 (b) PURPOSE.—The purpose of this Act is to provide 

4 better care and outcomes for Medicare beneficiaries living 

5 with Alzheimer’s disease and related dementias by build6 ing upon existing Medicare coverage of a diagnostic eval7 uation for Alzheimer’s disease and related dementias to 

8 add coverage of initial comprehensive care planning serv9 ices for Medicare beneficiaries who are first diagnosed 

10 with Alzheimer’s disease or related dementias on or after 

11 the date of the enactment of this Act and whose medical 

12 records contain the documented diagnosis of the disease. 

13 SEC. 3. MEDICARE COVERAGE OF COMPREHENSIVE ALZ14 HEIMER’S DISEASE CARE PLANNING SERV15 ICES. 

16 (a) IN GENERAL.—Section 1861 of the Social Secu17 rity Act (42 U.S.C. 1395x) is amended— 

18 (1) in subsection (s)(2)— 

19 (A) by striking ‘‘and’’ at the end of sub20 paragraph (EE); 

21 (B) by adding ‘‘and’’ at the end of sub22 paragraph (FF); and 

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

24 subparagraph: 


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1 ‘‘(GG) comprehensive Alzheimer’s disease care 

2 planning 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 Care Planning 

7 Services 

8 ‘‘(iii)(1)(A) Subject to subparagraph (B), the term 

9 ‘comprehensive Alzheimer’s disease care planning services’ 

10 means the services described in paragraph (2) furnished 

11 by a physician or non-physician practitioner to any or all 

12 of the following: 

13 ‘‘(i) An eligible individual. 

14 ‘‘(ii) The personal representative of such eligible 

15 individual, with or without the presence of the eligi16 ble individual. 

17 ‘‘(iii) One or more family caregivers of such eli18 gible individual, with or without the presence of the 

19 eligible individual. 

20 ‘‘(B) The Secretary shall establish guidelines for the 

21 furnishing of Comprehensive Alzheimer’s disease care 

22 planning services to individuals described in clauses (i), 

23 (ii), and (iii) of subparagraph (A). 

24 ‘‘(2)(A) Subject to the succeeding provisions of this 

25 paragraph, the services described in this paragraph are 


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1 the development and furnishing of an initial comprehen2 sive care plan to an eligible individual that provides such 

3 information and services as the Secretary may specify (in 

4 consultation with stakeholders as provided in paragraph 

5 (5)), which— 

6 ‘‘(i) includes— 

7 ‘‘(I) assistance understanding the di8 agnosis; 

9 ‘‘(II) assistance understanding med10 ical and non-medical options for ongoing 

11 treatment, services, and supports; and 

12 ‘‘(III) information about how to ob13 tain the treatments, services, and supports 

14 described in subclause (II); and 

15 ‘‘(ii) takes into account the eligible individ16 ual’s other co-morbid chronic conditions. 

17 ‘‘(B) The services described in this paragraph shall 

18 also include comprehensive medical record documentation, 

19 with respect to the eligible individual of the care planning 

20 services under subparagraph (A), by the physician or non21 physician practitioner furnishing the services. 

22 ‘‘(3) Subject to paragraph (5), the Secretary shall pe23 riodically update requirements under this subsection to re24 flect advances in science and technology. 


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1 ‘‘(4)(A) Comprehensive Alzheimer’s disease care 

2 planning services may only be furnished once with respect 

3 to each eligible individual. 

4 ‘‘(B) Nothing in this subsection shall be construed 

5 as prohibiting an update of any initial comprehensive care 

6 plan furnished under this subsection to an eligible indi7 vidual under physicians’ services that are covered under 

8 other provisions of this title, such as care planning under 

9 personalized prevention plan services (as defined in sub10 section (hhh)(1)). 

11 ‘‘(5) The Secretary shall consult with stakeholders, 

12 such as physicians, non-physician practitioners, and orga13 nizations that represent individuals (including individuals 

14 under this title) with Alzheimer’s disease, with respect to 

15 each of the following: 

16 ‘‘(A) The scope of, and requirements for, serv17 ices described in paragraph (2). 

18 ‘‘(B) The periodic updates of requirements 

19 under paragraph (3). 

20 ‘‘(6) In this subsection: 

21 ‘‘(A) The term ‘Alzheimer’s disease’ means Alz22 heimer’s disease and related dementias. 

23 ‘‘(B) The term ‘eligible individual’ means an in24 dividual who— 


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1 ‘‘(i) has a documented diagnosis of Alz2 heimer’s disease in the medical record; and 

3 ‘‘(ii) was first diagnosed as having Alz4 heimer’s disease on or after the date of the en5 actment of this subsection. 

6 ‘‘(C) The term ‘non-physician practitioner’ 

7 means a practitioner described in clause (i), (iv), or 

8 (v) of section 1842(b)(18)(C). 

9 ‘‘(D) The term ‘personal representative’ means, 

10 with respect to an individual, a person legally au11 thorized to make health care decisions on such indi12 vidual’s behalf. 

13 ‘‘(E) The term ‘physician’ has the meaning 

14 given that term in subsection (r)(1).’’. 

15 (b) PAYMENT.— 

16 (1) IN GENERAL.—Section 1833(a)(1) of the 

17 Social Security Act (42 U.S.C. 1395l(a)(1)) is 

18 amended— 

19 (A) by striking ‘‘and’’ before ‘‘(Z)’’; and 

20 (B) by inserting before the semicolon at 

21 the end the following: ‘‘, and (AA) with respect 

22 to comprehensive Alzheimer’s disease care plan23 ning services (as defined in section 

24 1861(iii)(2)), the amount paid shall be an 

25 amount equal to 80 percent of the lesser of the 


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1 actual charge for the services or the amount de2 termined under the payment basis determined 

3 under section 1848.’’. 

4 (2) PAYMENT UNDER PHYSICIAN FEE SCHED5 ULE.—Section 1848(j)(3) of the Social Security Act 

6 (42 U.S.C. 1395w–4(j)(3)) is amended by inserting 

7 ‘‘(2)(GG),’’ after ‘‘(2)(FF) (including administration 

8 of the health risk assessment),’’. 

9 (3) FREQUENCY LIMITATION.—Section 

10 1862(a)(1) of the Social Security Act (42 U.S.C. 

11 1395y(a)(1)) is amended— 

12 (A) in subparagraph (O), by striking 

13 ‘‘and’’ at the end; 

14 (B) in subparagraph (P), by striking the 

15 semicolon at the end and inserting ‘‘, and’’; and 

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

17 subparagraph: 

18 ‘‘(Q) in the case of comprehensive Alzheimer’s 

19 disease care planning services (as defined in section 

20 1861(iii)(1)), which are performed more frequently 

21 than is covered under such section;’’. 

22 (c) PROVIDER OUTREACH AND REPORTING ON CARE

23 PLANNING SERVICES.— 

24 (1) OUTREACH.—The Secretary of Health and 

25 Human Services (in this subsection referred to as 


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1 the ‘‘Secretary’’) shall conduct outreach to physi2 cians and appropriate non-physician practitioners 

3 participating under the Medicare program with re4 spect to the amendments made by subsections (a) 

5 and (b). Such outreach shall include a comprehen6 sive, one-time education initiative to inform such 

7 physicians and practitioners of the addition of com8 prehensive Alzheimer’s disease care planning services 

9 as a covered benefit under the Medicare program, 

10 including materials on appropriate diagnostic evalua11 tions and explanations of the requirements for eligi12 bility for such services. 

13 (2) REPORTS TO CONGRESS.— 

14 (A) PROVIDER OUTREACH.—Not later than 

15 one year after the effective date of the amend16 ments made by subsections (a) and (b) (as de17 scribed in subsection (d)), the Secretary shall 

18 submit to the Committee on Ways and Means 

19 and the Committee on Energy and Commerce 

20 of the House of Representatives and the Com21 mittee on Finance of the Senate a report on the 

22 outreach conducted under paragraph (1). Such 

23 report shall include a description of the meth24 ods used for such outreach. 


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1 (B) UTILIZATION RATES.—Not later than 

2 18 months after the effective date of the 

3 amendments made by subsections (a) and (b) 

4 (as described in subsection (d)) and annually 

5 thereafter for the succeeding five years, the 

6 Secretary shall submit to the Committee on 

7 Ways and Means and the Committee on Energy 

8 and Commerce of the House of Representatives 

9 and the Committee on Finance of the Senate a 

10 report on the number of Medicare beneficiaries 

11 who, during the preceding year, were furnished 

12 comprehensive Alzheimer’s disease care plan13 ning services for which payment was made 

14 under title XVIII of the Social Security Act (42 

15 U.S.C. 1395 et seq.). Each such report shall in16 clude information on any barriers Medicare 

17 beneficiaries face to access such services and 

18 the Secretary’s recommendations to eliminate 

19 any such barriers. 

20 (C) COPY OF EACH REPORT.—On the same 

21 day that a report is submitted under subpara22 graph (A) or (B) of paragraph (2), the Sec23 retary shall transmit a copy of such report to 

24 the Advisory Council on Alzheimer’s Research, 

25 Care, and Services (established under section 


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1 2(e) of the National Alzheimer’s Project Act 

2 (Public Law 111–375). 

3 (d) EFFECTIVE DATE.—The amendments made by 

4 subsections (a) and (b) shall apply to services furnished 

5 on or after January 1 of the year following the year which 

6 includes the date of the enactment of this Act. 

Æ 


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