I 
117TH CONGRESS 
1ST SESSION H. R. 2517 
To recommend that the Center for Medicare and Medicaid Innovation test 
the effect of a dementia care management model, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 14, 2021 
Mr. HIGGINS of New York (for himself, Mr. LAHOOD, Mr. TONKO, and Mr. 
GUTHRIE) introduced the following bill; which was referred to the Com-
mittee 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 recommend that the Center for Medicare and Medicaid 
Innovation test the effect of a dementia care manage-
ment model, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Comprehensive Care 
for Alzheimer’s Act’’. 
SEC. 2. CMI TESTING OF DEMENTIA CARE MANAGEMENT. 
Section 1115A of the Social Security Act (42 U.S.C. 
1315a) is amended— 
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‘‘(B) VOLUNTARY
PARTICIPATION.—Par-
ticipation under the Dementia Care Manage-
ment Model shall be voluntary with respect to 
both eligible individuals and eligible entities. 
‘‘(C) IMPLEMENTATION
OF
DEMENTIA 
CARE MANAGEMENT MODEL.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall— 
‘‘(I) implement the Dementia 
Care Management Model as a stand- 
alone model; 
‘‘(II) incorporate the Dementia 
Care Management Model into the Pri-
mary Care First Model; or 
‘‘(III) incorporate the Dementia 
Care Management Model into— 
‘‘(aa) 
the 
Primary 
Care 
First Model; and 
‘‘(bb) the Direct Contracting 
Model. 
‘‘(ii) 
ADDITIONAL
AUTHORITY.—In 
addition to the models described in sub-
clauses (I) through (III) of clause (i), the 
Secretary may incorporate the Dementia 
Care Management Model into other exist-
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ing coordinated care models established 
under title XVIII or under this section, in-
cluding accountable care organizations, 
value-based purchasing arrangements, and 
such other coordinated care models as the 
Secretary determines to be appropriate. 
‘‘(2) 
COMPREHENSIVE
CARE
MANAGEMENT 
SERVICES DEFINED.—In this subsection, the term 
‘comprehensive care management services’ means 
the following services furnished by an eligible entity 
with respect to an eligible individual: 
‘‘(A) CONTINUOUS MONITORING AND AS-
SESSMENT.—An eligible entity shall regularly 
assess and continuously monitor the following: 
‘‘(i) Neuropsychiatric symptoms, in-
cluding behavior, physical safety, and func-
tion of an eligible individual. 
‘‘(ii) Comorbidities. 
‘‘(iii) Financial resources and needs. 
‘‘(iv) Caregiver supports and re-
sources, including caregiver education, 
training, and support. 
‘‘(v) The well-being of unpaid care-
givers of the eligible individual. 
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‘‘(vi) Potential risks and harms of the 
eligible individual’s home and environment 
and the need for support for activities of 
daily living. 
‘‘(B) ONGOING DEMENTIA CARE PLAN.— 
An eligible entity shall develop and implement 
an Alzheimer’s disease or related dementia care 
plan, including advance care planning as appro-
priate, for an eligible individual. The care plan 
shall include patient-centered goals for the eligi-
ble individual as well as goals for unpaid care-
givers of the eligible individual. Such care plan 
shall be continuously evaluated and modified as 
appropriate. 
‘‘(C) PSYCHOSOCIAL INTERVENTIONS.—An 
eligible entity may implement psychosocial 
interventions designed to prevent or reduce the 
burden of cognitive, functional, behavioral, and 
psychological challenges as well as the associ-
ated stress on unpaid caregivers of the eligible 
individual. 
‘‘(D) SELF-MANAGEMENT TOOLS.—An eli-
gible entity shall provide self-management tools 
to enhance the skills of the unpaid caregiver of 
the eligible individual to manage the Alz-
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heimer’s disease or related dementia of the eli-
gible individual and to navigate the health care 
system. Such tools shall include training and 
support for unpaid caregivers in managing the 
limitations of eligible individuals, including edu-
cation, problem solving strategies, care naviga-
tion support, support after discharge from a 
hospital or nursing home, and decision-making 
support. 
‘‘(E) MEDICATION MANAGEMENT.—An eli-
gible entity shall furnish evidence-based medica-
tion review and management services to an eli-
gible individual, including polypharmacy man-
agement, using a planned process to reduce or 
stop medications that may no longer be of ben-
efit or may be having adverse cognitive effects, 
prescribing approved medications, and enhanc-
ing adherence to appropriate medications. 
‘‘(F) TREATMENT
OF
RELATED
CONDI-
TIONS.—An eligible entity shall provide inter-
ventions to prevent or treat conditions related 
to the Alzheimer’s disease or related dementia 
of the eligible individual, such as depression 
and delirium. 
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‘‘(G) CARE
COORDINATION.—An eligible 
entity shall provide ongoing care management 
services and shall coordinate services and sup-
ports among providers of services and suppliers, 
as well as social and community resources. 
Such services shall include necessary assistance 
for referrals to social and community-based or-
ganizations, collaboration with primary care 
providers and the interdisciplinary team of the 
eligible individual, and support for care transi-
tions and continuity of care. 
‘‘(H) EXCLUSION
OF
PALLIATIVE
CARE 
AND HOSPICE CARE.—Comprehensive care man-
agement services shall not include palliative 
care or hospice care. 
‘‘(I) OTHER
SERVICES.—The Secretary 
may require or permit other services, as appro-
priate. 
‘‘(3) ELIGIBLE ENTITY DEFINED.—In this sub-
section, the term ‘eligible entity’ means an entity, 
such as a health system, hospital, physician or non-
physician group practice, multiple physician prac-
tices, a Federally qualified health center, a rural 
health clinic, or an accountable care organization, 
that— 
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‘‘(A) is qualified to furnish comprehensive 
care management services to an eligible indi-
vidual, and any unpaid caregiver of such eligible 
individual, under the Dementia Care Manage-
ment Model either directly or through arrange-
ments with Medicare participating providers of 
services and suppliers as well as social and com-
munity-based organizations; 
‘‘(B) is accountable for the quality of com-
prehensive care management services furnished 
to an eligible individual under the model; 
‘‘(C) furnishes comprehensive care man-
agement services through an interdisciplinary 
team that has at least 1 physician, physician 
assistant, nurse practitioner, or advanced prac-
tice nurse who devotes 25 percent or more of 
patient contact time to the evaluation and care 
of patients with acquired cognitive impairment; 
‘‘(D) furnishes comprehensive care man-
agement services in a culturally appropriate 
manner; 
‘‘(E) utilizes a comprehensive, person-cen-
tered care management approach; 
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‘‘(F) furnishes wellness and healthcare 
planning, including medication review and man-
agement; 
‘‘(G) supports family and caregiver engage-
ment; 
‘‘(H) provides access to a primary care 
provider or a member of the interdisciplinary 
team 24 hours a day 7 days a week; 
‘‘(I) has relationships with medical and 
nonmedical community-based organizations that 
support patients with Alzheimer’s disease or a 
related dementia and their caregivers; and 
‘‘(J) meets such other requirements as the 
Secretary may determine to be appropriate. 
‘‘(4) ELIGIBLE INDIVIDUAL DEFINED.—In this 
subsection, the term ‘eligible individual’ means an 
individual— 
‘‘(A) who— 
‘‘(i) is entitled to, or enrolled for, ben-
efits under part A of title XVIII and en-
rolled under part B of such title (including 
such an individual who is a dual eligible in-
dividual 
described 
in 
subsection 
(a)(4)(A)(iii)); and 
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‘‘(ii) is not enrolled under part C of 
such title or under a PACE program under 
section 1894; 
‘‘(B) who has been diagnosed with a form 
of dementia; 
‘‘(C) who has not made an election to re-
ceive hospice care; and 
‘‘(D) who is not a resident of a nursing 
home. 
‘‘(5) PATIENT PATHWAYS.— 
‘‘(A) INITIAL PLACEMENT.— 
‘‘(i) PLACEMENT OF PATIENTS INTO 
CARE PATHWAYS.—An eligible entity shall 
assign an eligible individual to an appro-
priate pathway (as described in clauses 
(ii), (iii), and (iv)) based on an assessment 
of the clinical and financial status of the 
eligible individual that is conducted not 
later than 60 days after the eligible indi-
vidual is enrolled in the model. 
‘‘(ii) PATHWAY FOR UNCOMPLICATED 
DEMENTIA
DIAGNOSIS.—During the pre-
ceding 12-month period, the eligible indi-
vidual has not more than 1 unplanned in-
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patient hospitalization or visit to a hospital 
emergency department. 
‘‘(iii) PATHWAY FOR DEMENTIA DIAG-
NOSIS WITH ENHANCED CARE COORDINA-
TION NEEDS.—During the preceding 12- 
month period, the eligible individual— 
‘‘(I)(aa) has 2 or more un-
planned inpatient hospitalizations or 
visits to a hospital emergency depart-
ment; or 
‘‘(bb) has a psychiatric hos-
pitalization; and 
‘‘(II) has sufficient financial or 
caregiver resources (as determined by 
the Secretary). 
‘‘(iv) PATHWAY FOR DEMENTIA DIAG-
NOSIS WITH COMPLEX CARE NEEDS.—Dur-
ing the preceding 12-month period, the eli-
gible individual— 
‘‘(I)(aa) has 2 or more un-
planned inpatient hospitalizations or 
visits to a hospital emergency depart-
ment; or 
‘‘(bb) has a psychiatric hos-
pitalization; and 
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‘‘(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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