I 
112TH CONGRESS 
1ST SESSION H. R. 1386 
To amend title XVIII of the Social Security Act to provide for Medicare 
coverage of comprehensive Alzheimer’s disease and related dementia diag-
nosis and services in order to improve care and outcomes for Americans 
living with Alzheimer’s disease and related dementias by improving detec-
tion, diagnosis, and care planning. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 6, 2011 
Mr. MARKEY (for himself, Mr. SMITH of New Jersey, Ms. BORDALLO, Mr. 
BURGESS, Mrs. CHRISTENSEN, Mr. GRIJALVA, Mr. MCDERMOTT, and 
Mr. PIERLUISI) 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 provide 
for Medicare coverage of comprehensive Alzheimer’s dis-
ease and related dementia diagnosis and services in order 
to improve care and outcomes for Americans living with 
Alzheimer’s disease and related dementias by improving 
detection, diagnosis, and care planning. 
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 ‘‘Health Outcomes, 
Planning, and Education for Alzheimer’s Act’’. 
SEC. 2. MEDICARE COVERAGE OF COMPREHENSIVE ALZ-
HEIMER’S DISEASE DIAGNOSIS AND SERV-
ICES. 
(a) IN GENERAL.—Section 1861 of the Social Secu-
rity Act is amended— 
(1) in subsection (s)(2)— 
(A) by striking ‘‘and’’ at the end of sub-
paragraph (EE); 
(B) by adding ‘‘and’’ at the end of sub-
paragraph (FF); and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(GG) comprehensive Alzheimer’s disease diag-
nosis and services (as defined in subsection (iii));’’; 
and 
(2) by adding at the end the following new sub-
section: 
‘‘Comprehensive Alzheimer’s Disease Diagnosis and 
Services 
‘‘(iii)(1) The term ‘comprehensive Alzheimer’s disease 
diagnosis and services’ means the services described in 
paragraph (2) furnished to an individual— 
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‘‘(A) who does not already have a diagnosis of 
Alzheimer’s disease; and 
‘‘(B) for whom a physician or a practitioner de-
scribed in clause (i), (iv), or (v) of section 
1842(b)(18)(C), in a medical setting such as a phy-
sician’s office, a hospital, a skilled nursing facility, 
a community health center, or another similar med-
ical setting— 
‘‘(i) has detected the individual may have 
a cognitive impairment or dementia; and 
‘‘(ii) pursuant to such detection, has deter-
mined a diagnostic evaluation for Alzheimer’s 
disease is needed. 
‘‘(2) The services described in this paragraph are the 
following: 
‘‘(A) A diagnostic evaluation, including referral 
to a specialist if recommended. 
‘‘(B) If the individual is diagnosed with Alz-
heimer’s disease under the diagnostic evaluation 
under subparagraph (A), care planning services 
(with the individual or with one or more family care-
givers of the individual without the presence of the 
individual), including assistance understanding the 
diagnosis as well as the medical and non-medical op-
tions for ongoing treatment, services, and supports, 
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and information about how to obtain such treat-
ments, services, and supports. 
‘‘(C) Medical record documentation, with re-
spect to an individual, of the diagnostic evaluation 
under subparagraph (A), the diagnosis, and any care 
planning services under subparagraph (B). 
‘‘(3) In this subsection, the term ‘Alzheimer’s disease’ 
means Alzheimer’s disease and related dementias.’’. 
(b) PAYMENT.—Section 1833(a)(1) of the Social Se-
curity Act (42 U.S.C. 1395l(a)(1)) is amended by striking 
‘‘and’’ before ‘‘(Z)’’ and inserting before the semicolon at 
the end the following: ‘‘, and (AA) with respect to com-
prehensive Alzheimer’s disease diagnosis and services (as 
defined in section 1861(iii)), the amount paid shall be an 
amount equal to 80 percent of the amount determined 
under a fee schedule designated by the Secretary’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to services furnished on or after 
January 1 of the year following the year which includes 
the date of the enactment of this Act. 
Æ 
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