I 
113TH CONGRESS 
1ST SESSION H. R. 1507 
To amend title XVIII of the Social Security Act to increase diagnosis of 
Alzheimer’s disease and related dementias, leading to better care and 
outcomes for Americans living with Alzheimer’s disease and related de-
mentias. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 11, 2013 
Mr. MARKEY (for himself, Mr. SMITH of New Jersey, Mr. BURGESS, Mrs. 
CAPITO, Ms. SPEIER, Mr. JOHNSON of Georgia, Ms. TSONGAS, Ms. NOR-
TON, Mr. FATTAH, Ms. MOORE, Mrs. CAROLYN B. MALONEY of New 
York, Mr. RUNYAN, Mr. SCHIFF, Mr. ROSKAM, Mr. GARAMENDI, Mr. 
TIERNEY, Mr. ISRAEL, and Ms. EDDIE BERNICE JOHNSON of Texas) in-
troduced the following bill; which was referred to the Committee on En-
ergy 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 jurisdic-
tion of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to increase 
diagnosis of Alzheimer’s disease and related dementias, 
leading to better care and outcomes for Americans living 
with Alzheimer’s disease and related dementias. 
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. FINDINGS AND PURPOSE. 
(a) FINDINGS.—Congress makes the following find-
ings: 
(1) As many as half of the estimated 5.2 mil-
lion Americans with Alzheimer’s disease have never 
received a diagnosis. 
(2) An early and documented diagnosis and ac-
cess to care planning services leads to better out-
comes for individuals with Alzheimer’s disease and 
other dementias and their caregivers. 
(3) Combining the existing Medicare benefits of 
a diagnostic evaluation and care planning into a sin-
gle package of services would help ensure that indi-
viduals receive an appropriate diagnosis as well as 
critical information about the disease and available 
care options, which leads to better outcomes. 
(4) An accurate diagnosis allows for better 
management of other known chronic conditions and 
more efficient utilization of medical resources, in-
cluding reducing complications and the number of 
costly emergency room visits and hospitalizations. 
(5) A formal diagnosis allows individuals and 
their caregivers to have access to available medical 
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and non-medical treatments, build a care team, par-
ticipate in support services, and enroll in clinical 
trials. 
(6) Undertaking the diagnostic process poten-
tially allows cognitive impairment to be reversed, as 
the cognitive impairment of nine percent of individ-
uals experiencing dementia-like symptoms is due to 
a potentially reversible cause, such as depression or 
vitamin deficiency. 
(b) PURPOSE.—The purpose of this Act is to increase 
diagnosis of Alzheimer’s disease and related dementias, 
leading to better care and outcomes for Americans living 
with Alzheimer’s disease and related dementias. 
SEC. 3. MEDICARE COVERAGE OF COMPREHENSIVE ALZ-
HEIMER’S DISEASE DIAGNOSIS AND SERV-
ICES. 
(a) IN GENERAL.—Section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395x) 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: 
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‘‘(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— 
‘‘(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: 
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‘‘(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, with the personal representative 
of the individual, or with one or more family care-
givers of the individual with or without the presence 
of the individual), including assistance under-
standing the diagnosis as well as the medical and 
non-medical options for ongoing treatment, services, 
and supports, and information about how to obtain 
such treatments, services, and supports. Such care 
planning services for individuals diagnosed with Alz-
heimer’s disease should take into consideration and 
address other co-morbid chronic conditions. 
‘‘(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— 
‘‘(A) the term ‘Alzheimer’s disease’ means Alz-
heimer’s disease and related dementias; and 
‘‘(B) the term ‘personal representative’ means, 
with respect to an individual, a person legally au-
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thorized to make health care decisions on such indi-
vidual’s behalf.’’. 
(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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