I 
114TH CONGRESS 
1ST SESSION H. R. 1559 
To amend title XVIII of the Social Security Act to provide for coverage 
under the Medicare program of an initial comprehensive care plan for 
Medicare beneficiaries newly diagnosed with Alzheimer’s disease and re-
lated dementias, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 24, 2015 
Mr. SMITH of New Jersey (for himself, Ms. MAXINE WATERS of California, 
Mr. ROSKAM, Mr. FATTAH, Mr. TONKO, Mr. BLUMENAUER, Mr. 
GARAMENDI, Mr. DUNCAN of Tennessee, Mr. BUCHANAN, Mr. MURPHY 
of Florida, Mr. HINOJOSA, Mr. DAVID SCOTT of Georgia, Mr. YARMUTH, 
Ms. FRANKEL of Florida, Mr. JOHNSON of Georgia, Mr. CAPUANO, Mr. 
HIGGINS, Mr. LOEBSACK, Ms. PINGREE, Ms. WILSON of Florida, Ms. 
SLAUGHTER, Mr. KEATING, Mr. SIRES, Mr. JOYCE, Mr. SARBANES, Ms. 
KUSTER, Mr. GRIJALVA, Mr. WALZ, Mr. HARPER, Mr. DEUTCH, Mr. 
RANGEL, Ms. CLARK
of Massachusetts, Ms. NORTON, and Mr. 
BARLETTA) 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 amend title XVIII of the Social Security Act to provide 
for coverage under the Medicare program of an initial 
comprehensive care plan for Medicare beneficiaries newly 
diagnosed with Alzheimer’s disease and related demen-
tias, and for other purposes. 
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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 ‘‘Health Outcomes, 
Planning, and Education (HOPE) for Alzheimer’s Act of 
2015’’. 
SEC. 2. FINDINGS AND PURPOSE. 
(a) FINDINGS.—Congress makes the following find-
ings: 
(1) As many as half of the estimated 5,100,000 
American seniors with Alzheimer’s disease and other 
dementias 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) Building upon the existing Medicare benefit 
of a diagnostic evaluation to add comprehensive care 
planning services would help ensure that bene-
ficiaries and their families receive critical informa-
tion about the disease and available care options, 
which leads to better outcomes. 
(4) An accurate, timely, and documented diag-
nosis allows for better management of other known 
chronic conditions and more efficient utilization of 
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medical resources, including reducing complications 
and the number of costly emergency room visits and 
hospitalizations. 
(5) A formal and documented diagnosis and 
care planning services allow individuals and their 
caregivers to have access to available medical and 
non-medical treatments, build a care team, partici-
pate in support services, and enroll in clinical trials. 
(b) PURPOSE.—The purpose of this Act is to provide 
better care and outcomes for Medicare beneficiaries living 
with Alzheimer’s disease and related dementias by build-
ing upon existing Medicare coverage of a diagnostic eval-
uation for Alzheimer’s disease and related dementias to 
add coverage of initial comprehensive care planning serv-
ices for Medicare beneficiaries who are first diagnosed 
with Alzheimer’s disease or related dementias on or after 
the date of the enactment of this Act and whose medical 
records contain the documented diagnosis of the disease. 
SEC. 3. MEDICARE COVERAGE OF COMPREHENSIVE ALZ-
HEIMER’S DISEASE CARE PLANNING 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)— 
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(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 care 
planning services (as defined in subsection (iii));’’; 
and 
(2) by adding at the end the following new sub-
section: 
‘‘Comprehensive Alzheimer’s Disease Care Planning 
Services 
‘‘(iii)(1)(A) Subject to subparagraph (B), the term 
‘comprehensive Alzheimer’s disease care planning services’ 
means the services described in paragraph (2) furnished 
by a physician or non-physician practitioner to any or all 
of the following: 
‘‘(i) An eligible individual. 
‘‘(ii) The personal representative of such eligible 
individual, with or without the presence of the eligi-
ble individual. 
‘‘(iii) One or more family caregivers of such eli-
gible individual, with or without the presence of the 
eligible individual. 
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‘‘(B) The Secretary shall establish guidelines for the 
furnishing of Comprehensive Alzheimer’s disease care 
planning services to individuals described in clauses (i), 
(ii), and (iii) of subparagraph (A). 
‘‘(2)(A) Subject to the succeeding provisions of this 
paragraph, the services described in this paragraph are 
the development and furnishing of an initial comprehen-
sive care plan to an eligible individual that provides such 
information and services as the Secretary may specify (in 
consultation with stakeholders as provided in paragraph 
(5)), which— 
‘‘(i) includes— 
‘‘(I) assistance understanding the diag-
nosis; 
‘‘(II) assistance understanding medical and 
non-medical options for ongoing treatment, 
services, and supports; and 
‘‘(III) information about how to obtain the 
treatments, services, and supports described in 
subclause (II); and 
‘‘(ii) takes into account the eligible individual’s 
other co-morbid chronic conditions. 
‘‘(B) The services described in this paragraph shall 
also include comprehensive medical record documentation, 
with respect to the eligible individual of the care planning 
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services under subparagraph (A), by the physician or non- 
physician practitioner furnishing the services. 
‘‘(3) Subject to paragraph (5), the Secretary shall pe-
riodically update requirements under this subsection to re-
flect advances in science and technology. 
‘‘(4)(A) Comprehensive Alzheimer’s disease care 
planning services may only be furnished once with respect 
to each eligible individual. 
‘‘(B) Nothing in this subsection shall be construed 
as prohibiting an update of any initial comprehensive care 
plan furnished under this subsection to an eligible indi-
vidual under physicians’ services that are covered under 
other provisions of this title, such as care planning under 
personalized prevention plan services (as defined in sub-
section (hhh)(1)). 
‘‘(5) The Secretary shall consult with stakeholders, 
such as physicians, non-physician practitioners, and orga-
nizations that represent individuals (including individuals 
under this title) with Alzheimer’s disease, with respect to 
each of the following: 
‘‘(A) The scope of, and requirements for, serv-
ices described in paragraph (2). 
‘‘(B) The periodic updates of requirements 
under paragraph (3). 
‘‘(6) In this subsection: 
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‘‘(A) The term ‘Alzheimer’s disease’ means Alz-
heimer’s disease and related dementias. 
‘‘(B) The term ‘eligible individual’ means an in-
dividual who— 
‘‘(i) has a documented diagnosis of Alz-
heimer’s disease in the medical record; and 
‘‘(ii) was first diagnosed as having Alz-
heimer’s disease on or after the date of the en-
actment of this subsection. 
‘‘(C) The term ‘non-physician practitioner’ 
means a practitioner described in clause (i), (iv), or 
(v) of section 1842(b)(18)(C). 
‘‘(D) The term ‘personal representative’ means, 
with respect to an individual, a person legally au-
thorized to make health care decisions on such indi-
vidual’s behalf. 
‘‘(E) The term ‘physician’ has the meaning 
given that term in subsection (r)(1).’’. 
(b) PAYMENT.— 
(1) IN GENERAL.—Section 1833(a)(1) of the 
Social Security Act (42 U.S.C. 1395l(a)(1)) is 
amended— 
(A) by striking ‘‘and’’ before ‘‘(Z)’’; and 
(B) by inserting before the semicolon at 
the end the following: ‘‘, and (AA) with respect 
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to comprehensive Alzheimer’s disease care plan-
ning 
services 
(as 
defined 
in 
section 
1861(iii)(2)), the amount paid shall be an 
amount equal to 80 percent of the lesser of the 
actual charge for the services or the amount de-
termined under the payment basis determined 
under section 1848.’’. 
(2) PAYMENT UNDER PHYSICIAN FEE SCHED-
ULE.—Section 1848(j)(3) of the Social Security Act 
(42 U.S.C. 1395w–4(j)(3)) is amended by inserting 
‘‘(2)(GG),’’ after ‘‘(2)(FF) (including administration 
of the health risk assessment),’’. 
(3) 
FREQUENCY
LIMITATION.—Section 
1862(a)(1) of the Social Security Act (42 U.S.C. 
1395y(a)(1)) is amended— 
(A) in subparagraph (O), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (P), by striking the 
semicolon at the end and inserting ‘‘, and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(Q) in the case of comprehensive Alzheimer’s 
disease care planning services (as defined in section 
1861(iii)(1)), which are performed more frequently 
than is covered under such section;’’. 
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(c) PROVIDER OUTREACH AND REPORTING ON CARE 
PLANNING SERVICES.— 
(1) OUTREACH.—The Secretary of Health and 
Human Services (in this subsection referred to as 
the ‘‘Secretary’’) shall conduct outreach to physi-
cians and appropriate non-physician practitioners 
participating under the Medicare program with re-
spect to the amendments made by subsections (a) 
and (b). Such outreach shall include a comprehen-
sive, one-time education initiative to inform such 
physicians and practitioners of the addition of com-
prehensive Alzheimer’s disease care planning services 
as a covered benefit under the Medicare program, 
including materials on appropriate diagnostic evalua-
tions and explanations of the requirements for eligi-
bility for such services. 
(2) REPORTS TO CONGRESS.— 
(A) PROVIDER OUTREACH.—Not later than 
one year after the effective date of the amend-
ments made by subsections (a) and (b) (as de-
scribed in subsection (d)), the Secretary shall 
submit to the Committee on Ways and Means 
and the Committee on Energy and Commerce 
of the House of Representatives and the Com-
mittee on Finance of the Senate a report on the 
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outreach conducted under paragraph (1). Such 
report shall include a description of the meth-
ods used for such outreach. 
(B) UTILIZATION RATES.—Not later than 
18 months after the effective date of the 
amendments made by subsections (a) and (b) 
(as described in subsection (d)) and annually 
thereafter for the succeeding five years, the 
Secretary shall submit to the Committee on 
Ways and Means and the Committee on Energy 
and Commerce of the House of Representatives 
and the Committee on Finance of the Senate a 
report on the number of Medicare beneficiaries 
who, during the preceding year, were furnished 
comprehensive Alzheimer’s disease care plan-
ning services for which payment was made 
under title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.). Each such report shall in-
clude information on any barriers Medicare 
beneficiaries face to access such services and 
the Secretary’s recommendations to eliminate 
any such barriers. 
(C) COPY OF EACH REPORT.—On the same 
day that a report is submitted under subpara-
graph (A) or (B) of paragraph (2), the Sec-
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retary shall transmit a copy of such report to 
the Advisory Council on Alzheimer’s Research, 
Care, and Services established under section 
2(e) of the National Alzheimer’s Project Act 
(42 U.S.C. 11225(e); Public Law 111–375). 
(d) EFFECTIVE DATE.—The amendments made by 
subsections (a) and (b) shall apply to services furnished 
on or after January 1 of the year beginning after the date 
of the enactment of this Act. 
Æ 
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