I 
118TH CONGRESS 
1ST SESSION H. R. 4752 
To amend title XVIII of the Social Security Act to provide for certain 
cognitive impairment detection in the Medicare annual wellness visit 
and initial preventive physical examination. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 19, 2023 
Ms. SA´NCHEZ (for herself, Mr. LAHOOD, Ms. MATSUI, Mr. BILIRAKIS, Ms. 
BARRAGA´N, Mrs. BEATTY, Mr. FITZPATRICK, Mr. GRIJALVA, Ms. NOR-
TON, Mrs. NAPOLITANO, Mr. POCAN, Ms. SHERRILL, Mr. STANTON, Ms. 
TITUS, Ms. TLAIB, Mr. VARGAS, and Ms. WATERS) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
for certain cognitive impairment detection in the Medi-
care annual wellness visit and initial preventive physical 
examination. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Concentrating on 
High-value Alzheimer’s Needs to Get to an End Act of 
2023’’ or the ‘‘CHANGE Act of 2023’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) It is estimated that 6.7 million Americans 
are living with Alzheimer’s disease, a number that is 
estimated to rise to nearly 13.8 million by 2060. 
About 1 in 9 people age 65 and older have Alz-
heimer’s. 
(2) Older Black Americans are twice as likely, 
and Latino Americans are 1.5 times as likely, to 
have Alzheimer’s disease than older White Ameri-
cans. Nearly two-thirds of Americans with Alz-
heimer’s disease are women. 
(3) In 2021, Alzheimer’s disease was the sev-
enth-leading cause of death in America. 
(4) Addressing modifiable risk factors for Alz-
heimer’s and other types of dementia such as hyper-
tension, physical inactivity, smoking, depression, dia-
betes, obesity, and poor nutrition might prevent or 
delay up to 40 percent of dementia cases. In 2021 
the National Plan to Addresses Alzheimer’s disease 
was updated to include a new goal to focus on reduc-
ing risk of developing dementia. 
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(5) An early documented diagnosis commu-
nicated to the patient and caregiver, enables early 
access to care planning services and available med-
ical and non-medical treatments, and optimizes pa-
tients’ ability to build a care team, participate in 
support services, and enroll in clinical trials. 
(6) Alzheimer’s exacts an emotional and phys-
ical toll on caregivers, resulting in higher incidence 
of heart disease, cancer, depression, and other health 
consequences. 
(7) More than 11 million Americans provide un-
paid care for people with Alzheimer’s or other de-
mentia and provided nearly $340 billion in unpaid 
care to people living with Alzheimer’s and other de-
mentia in 2022. 
(8) In 2023, it is estimated that Alzheimer’s 
and related dementia will cost our nation $345 bil-
lion, not including the value of unpaid caregiving. 
By 2050, it is estimated that these direct costs will 
increase to nearly $1 trillion. 
SEC. 3. COGNITIVE IMPAIRMENT DETECTION BENEFIT IN 
THE MEDICARE ANNUAL WELLNESS VISIT 
AND INITIAL PREVENTIVE PHYSICAL EXAM-
INATION. 
(a) ANNUAL WELLNESS VISIT.— 
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(1) IN GENERAL.—Section 1861(hhh)(2) of the 
Social Security Act (42 U.S.C. 1395x(hhh)(2)) is 
amended by striking subparagraph (D) and inserting 
the following: 
‘‘(D) Detection of any cognitive impair-
ment that shall— 
‘‘(i) be performed using one of the 
cognitive impairment detection tools identi-
fied by the National Institute on Aging as 
meeting its criteria for selecting instru-
ments to detect cognitive impairment in 
the primary care setting; and 
‘‘(ii) include documentation of the tool 
used for detecting cognitive impairment 
and results of the assessment in the pa-
tient’s medical record.’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall apply to annual wellness vis-
its furnished on or after January 1, 2024. 
(b) INITIAL
PREVENTIVE
PHYSICAL
EXAMINA-
TION.— 
(1) IN GENERAL.—Section 1861(ww)(1) of the 
Social Security Act (42 U.S.C. 1395x(ww)(1)) is 
amended by striking ‘‘agreement with the individual, 
and’’ and inserting ‘‘agreement with the individual, 
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detection of any cognitive impairment as described 
in subsection (hhh)(2)(D), and’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall apply to initial preventive 
physical examinations furnished on or after January 
1, 2024. 
Æ 
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