‘‘(II) has insufficient financial or 
caregiver resources (as determined by 
the Secretary). 
‘‘(B) REGULAR
PATIENT
ASSESSMENTS 
FOR APPROPRIATE PATHWAY.— 
‘‘(i) IN GENERAL.—After determina-
tion of the initial pathway, at a frequency 
to be determined by the Secretary, but not 
less than once per year, an eligible entity 
shall reassess the pathway determination 
of each eligible individual enrolled under 
the model. 
‘‘(ii) INCREASED ADL LIMITATIONS.— 
Each eligible individual enrolled in the 
pathway for uncomplicated dementia diag-
nosis 
(as 
described 
in 
subparagraph 
(A)(ii)) who has had increased limitations 
in performing activities of daily living since 
the prior assessment shall be assigned to 
the pathway for dementia diagnosis with 
enhanced care coordination needs (as de-
scribed in subparagraph (A)(iii)) or the 
pathway for dementia diagnosis with com-
plex care needs (as described in subpara-
graph (A)(iv)), depending on the eligible 
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individual’s financial and caregiver re-
sources applicable to each pathway. 
‘‘(iii) ENHANCED OR COMPLEX CARE 
NEEDS.—Each eligible individual enrolled 
in the pathway for dementia diagnosis with 
enhanced care coordination needs (as de-
scribed in subparagraph (A)(iii)) or the 
pathway for dementia diagnosis with com-
plex care needs (as described in subpara-
graph (A)(iv)) shall be assigned to 1 of the 
2 pathways based on the eligible individ-
ual’s financial and caregiver resources ap-
plicable to each pathway. 
‘‘(6) QUALITY ASSESSMENT.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
specify appropriate measures to assess the qual-
ity of care furnished by an eligible entity under 
the Dementia Care Management Model. Such 
measures shall include, as appropriate, meas-
ures for clinical processes and outcomes, patient 
and caregiver experience of care, and utilization 
of services for which payment is made under 
the original medicare fee-for-service program 
under title XVIII, including measures for— 
‘‘(i) emergency department utilization; 
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‘‘(ii) inpatient hospital utilization; 
‘‘(iii) documented advanced care plan; 
‘‘(iv) medication review; 
‘‘(v) screening for future fall risk; 
‘‘(vi) depression screening for care-
givers; 
‘‘(vii) caregiver stress assessment; and 
‘‘(viii) caregiver assessment of out-
comes. 
‘‘(B) REPORTING.—An eligible entity shall 
submit data in a form and manner determined 
by the Secretary on measures specified by the 
Secretary. 
‘‘(C) 
PERFORMANCE
ASSESSMENT.—In 
order to assess the quality of care furnished by 
an eligible entity under the model, the Sec-
retary shall establish— 
‘‘(i) quality performance standards; 
and 
‘‘(ii) methodologies for quality per-
formance scoring and related payment ad-
justments. 
‘‘(D) STAKEHOLDER
INPUT.—The Sec-
retary shall seek input from eligible entities on 
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final measure specifications, including appro-
priate adjustment for patient preferences. 
‘‘(7) PAYMENTS.— 
‘‘(A) IN GENERAL.—Under the Dementia 
Care Management Model, the Secretary shall 
establish payment amounts for care manage-
ment services furnished to eligible individuals, 
including 
initial 
investment 
costs. 
Such 
amounts shall reflect start-up costs and initial 
investments incurred by an eligible entity in es-
tablishing the Dementia Care Management 
Model. 
‘‘(B) CAPITATED BASIS.—Payments under 
the Dementia Care Management Model shall be 
made on a capitated basis, such as a per-mem-
ber, per-month payment, or such other similar 
payment mechanisms that the Secretary deter-
mines to be appropriate. Payments shall vary 
based on the assigned pathway of each patient 
as described in paragraph (5). 
‘‘(C) QUALITY BONUS.—Under the Demen-
tia Care Management Model, additional pay-
ments shall be made to any eligible entity for 
quality bonuses based on the performance of 
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the eligible entity in providing quality care (as 
determined under paragraph (6)). 
‘‘(D) ZERO COST-SHARING.—An eligible in-
dividual shall not be liable for any cost-sharing, 
including deductibles, coinsurance, or copay-
ments, for care management services for de-
mentia care furnished to such eligible individual 
under the model. 
‘‘(E) SUPPLEMENTAL TO PAYMENTS FOR 
COVERED
SERVICES.—Payments made under 
the model shall be in addition to any payments 
for items or services not provided under the 
model for which payment may be made under 
title XVIII for services furnished to such eligi-
ble individuals. 
‘‘(F) 
NONDUPLICATION.—Payments 
for 
care management services furnished to eligible 
individuals under the Dementia Care Manage-
ment Model may not duplicate payments for 
services furnished to such eligible individuals 
for which payments are made under the original 
medicare fee-for-service program under title 
XVIII. 
‘‘(8) WAIVERS.—The Secretary shall waive pro-
visions of this title, and title XVIII, to permit an eli-
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gible entity operating a Dementia Care Management 
Model to provide the following: 
‘‘(A) BENEFICIARY REWARDS.—Gift cards 
or other rewards for patients who successfully 
participate in the program (as determined by 
the Secretary). 
‘‘(B) CAREGIVERS.—Supports for care-
givers. 
‘‘(C) TELEHEALTH.—Telehealth services 
without regard to geographic or other origi-
nating site limitations under section 1834(m). 
‘‘(D) SERVICES FROM COMMUNITY ORGA-
NIZATIONS.—Payments, cost-sharing support, 
or both, for nonmedical services furnished by 
community-based organizations, such as limited 
caregiving services, respite care, adult day care 
counseling services, and such other services as 
the Secretary determines to be appropriate. 
‘‘(9) MODIFICATIONS FOR APPLICATION IN THE 
PRIMARY
CARE
FIRST
AND
DIRECT
CONTRACTING 
MODELS.— 
‘‘(A) IN
GENERAL.—Except as provided 
under subparagraph (B), if the Secretary elects 
to incorporate the Dementia Care Management 
Model into the Primary Care First Model, the 
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Direct Contracting Model, or both, as provided 
for under paragraph (1)(C)(i), the Secretary 
shall maintain the requirements of this sub-
section. 
‘‘(B) PERMISSIBLE MODIFICATIONS.—The 
Secretary may adjust the requirements of this 
subsection to the extent necessary to ensure 
consistency of the Dementia Care Management 
Model with the Primary Care First Model, the 
Direct Contracting Model, or both, with respect 
to— 
‘‘(i) any eligible entity, including bene-
ficiary alignment thresholds; 
‘‘(ii) any eligible individual; 
‘‘(iii) capitated payments; and 
‘‘(iv) quality-bonus payments. 
‘‘(C) 
CONSULTATION
WITH
STAKE-
HOLDERS.—Prior to making any adjustment 
under subparagraph (B), the Secretary shall 
consult with appropriate stakeholders and pa-
tient advocacy organizations. 
‘‘(10) OUTREACH TO UNDERREPRESENTED MI-
NORITY
POPULATIONS.—An eligible entity shall 
carry out public outreach and education efforts, in-
cluding the dissemination of information, for mem-
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bers of underrepresented minority populations re-
garding participation in the Dementia Care Manage-
ment Model to ensure diversity in the patient popu-
lation of such model. 
‘‘(11) OPTION TO EXPAND TO MEDICAID.—The 
Secretary may design a model under which pay-
ments are made under title XIX, in a similar man-
ner to the manner in which payments are made 
under title XVIII under the Dementia Care Manage-
ment Model described in this subsection, to eligible 
entities that furnish comprehensive care manage-
ment services to individuals who are eligible for med-
ical assistance under a State plan under title XIX 
(or a waiver of such a plan) with Alzheimer’s disease 
or a related dementia, in order to test the effective-
ness of comprehensive care management services on 
patient health, care quality, and care experience, as 
well as on unpaid caregivers, and on reducing spend-
ing under title XIX without reducing the quality of 
care.’’. 
Æ 
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