I 
115TH CONGRESS 
2D SESSION 
H. R. 4957 
To provide better care and outcomes for Americans living with Alzheimer’s 
disease and related dementias and their caregivers while accelerating 
progress toward prevention strategies, disease modifying treatments, and, 
ultimately, a cure. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 7, 2018 
Ms. SA´NCHEZ (for herself and Mr. ROSKAM) 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 subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To provide better care and outcomes for Americans living 
with Alzheimer’s disease and related dementias and their 
caregivers while accelerating progress toward prevention 
strategies, disease modifying treatments, and, ultimately, 
a cure. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS; FINDINGS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Concentrating on High-Value Alzheimer’s Needs to Get 
to an End (CHANGE) Act of 2018’’. 
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(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents; findings. 
Sec. 2. Cognitive impairment detection benefit in the Medicare annual wellness 
visit and initial preventive physical examination. 
Sec. 3. Test of care delivery models offering a continuum of comprehensive 
care, and caregiver support services, for patients with Alz-
heimer’s disease and other dementias. 
Sec. 4. State innovation models for family caregivers of patients with Alz-
heimer’s and related dementias. 
Sec. 5. Medicare quality payment program. 
Sec. 6. Report to Congress on implementation of this Act. 
Sec. 7. Study and report on regulatory and legislative changes or refinements 
that would accelerate Alzheimer’s disease research progress. 
(c) FINDINGS.—Congress finds as follows: 
(1) The number of individuals in the United 
States with Alzheimer’s disease and related demen-
tias has more than doubled since 1980 and, based 
on the trajectory of Alzheimer’s, as many as 14 to 
16 million individuals in the United States will have 
Alzheimer’s by 2050. 
(2) Alzheimer’s is the only disease among the 
top 10 causes of death in the United States without 
an effective means of prevention, treatment, or cure. 
(3) In 2017, Alzheimer’s care will cost Medicare 
and Medicaid an estimated $175,000,000,000 and 
by 2050, Alzheimer’s disease will cost Medicare and 
Medicaid as much as $758,000,000,000. 
(4) Alzheimer’s exacts an emotional and phys-
ical toll on caregivers, resulting in higher incidence 
of heart disease, cancer, depression, and other health 
consequences. 
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(5) Alzheimer’s disease disproportionately im-
pacts women and people of color. Women are twice 
as likely to develop Alzheimer’s as they are breast 
cancer. African Americans are about two times more 
likely than White Americans to have Alzheimer’s dis-
ease and other dementias. Latinos are about one 
and one-half times more likely than White Ameri-
cans to have Alzheimer’s disease and other demen-
tias. This higher prevalence translates into a higher 
death rate: Alzheimer’s deaths increased 55 percent 
among all Americans between 1999 and 2014, while 
the number was 107 percent for Latinos and 99 per-
cent for African Americans. 
(6) As many as half of the estimated 5,100,000 
American seniors with Alzheimer’s disease and other 
dementias have never received a diagnosis. 
(7) An early, documented diagnosis, commu-
nicated to the patient and caregiver, enables early 
access to care planning services and available med-
ical and nonmedical treatments, and optimizes pa-
tients’ ability to build a care team, participate in 
support services, and enroll in clinical trials. 
(8) The lack of uniform, reliable cognitive im-
pairment detection methodologies in the Medicare 
annual wellness visit, and appropriate follow-up, 
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