I 
115TH CONGRESS 
1ST SESSION H. R. 4256 
To amend the Public Health Service Act to authorize the expansion of 
activities related to Alzheimer’s disease, cognitive decline, and brain 
health under the Alzheimer’s Disease and Healthy Aging Program, and 
for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 6, 2017 
Mr. GUTHRIE (for himself, Mr. TONKO, Ms. MAXINE WATERS of California, 
and Mr. SMITH of New Jersey) introduced the following bill; which was 
referred to the Committee on Energy and Commerce 
A BILL 
To amend the Public Health Service Act to authorize the 
expansion of activities related to Alzheimer’s disease, cog-
nitive decline, and brain health under the Alzheimer’s 
Disease and Healthy Aging Program, and for other pur-
poses. 
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 ‘‘Building Our Largest 
Dementia Infrastructure for Alzheimer’s Act’’ or the 
‘‘BOLD Infrastructure for Alzheimer’s Act’’. 
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SEC. 2. FINDINGS. 
Congress finds as follows: 
(1) According to former Surgeon General and 
Director of the Centers for Disease Control and Pre-
vention, Dr. David Satcher, ‘‘Alzheimer’s is the most 
under-recognized threat to public health in the 21st 
century.’’. 
(2) Deaths from Alzheimer’s disease increased 
55 percent between 1999 and 2014 in the United 
States, according to data from the Centers for Dis-
ease Control and Prevention. 
(3) More than 5,000,000 people in the United 
States are living with Alzheimer’s disease and, with-
out significant efforts to change the current trajec-
tory, as many as 16,000,000 people in the United 
States will have Alzheimer’s disease by 2050. This 
explosive growth will cause costs associated with Alz-
heimer’s disease to increase from an estimated 
$259,000,000,000 
in 
2017 
to 
more 
than 
$1,100,000,000,000 in 2050 (in 2017 dollars). 
(4) Among individuals living with Alzheimer’s 
disease and other dementias, evidence indicates as 
many as 50 percent have not been diagnosed. 
Among individuals diagnosed with Alzheimer’s dis-
ease, only 33 percent are aware of the diagnosis. 
Early detection and diagnosis of Alzheimer’s disease 
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and other dementias allow people to access available 
treatments, build a care team, participate in support 
services, and enroll in clinical trials. Early detection 
can help physicians better manage a patient’s co-
morbid conditions and avoid prescribing medications 
that may worsen cognition or function. 
(5) Among individuals living with Alzheimer’s 
disease and other dementias, 25.3 percent experience 
a preventable hospitalization, and such preventable 
hospitalizations cost the Medicare program nearly 
$2,600,000,000 in 2013. 
(6) African Americans are about 2 times more 
likely than White Americans to have Alzheimer’s dis-
ease and other dementias. Hispanics are about one 
and one-half times more likely than White Ameri-
cans to have Alzheimer’s disease and other demen-
tias. 
(7) In 2016, 15,900,000 family members and 
friends provided 18,200,000,000 hours of unpaid 
care to individuals with Alzheimer’s disease and 
other dementias, at an economic value of over 
$230,000,000,000. The physical and emotional im-
pact of caregiving of individuals with Alzheimer’s 
disease and other dementia resulted in an estimated 
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$10,900,000,000 in increased caregiver health costs 
in 2016. 
(8) Strategy 4.B of the ‘‘National Plan to Ad-
dress Alzheimer’s Disease: 2017 Update’’ of the Of-
fice of the Assistant Secretary for Planning and 
Evaluation of the Department of Health and Human 
Services is to ‘‘work with State, Tribal, and local 
governments to improve coordination and identify 
model initiatives to advance Alzheimer’s disease 
awareness and readiness across the Government.’’. 
SEC. 3. PROMOTION OF PUBLIC HEALTH KNOWLEDGE AND 
AWARENESS OF ALZHEIMER’S DISEASE, COG-
NITIVE DECLINE, AND BRAIN HEALTH UNDER 
THE ALZHEIMER’S DISEASE AND HEALTHY 
AGING PROGRAM. 
Part P of title III of the Public Health Service Act 
(42 U.S.C. 280g et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 399V–7. PROMOTION OF PUBLIC HEALTH KNOWL-
EDGE AND AWARENESS OF ALZHEIMER’S DIS-
EASE, 
COGNITIVE 
DECLINE, 
AND 
BRAIN 
HEALTH UNDER THE ALZHEIMER’S DISEASE 
AND HEALTHY AGING PROGRAM. 
‘‘(a) DEFINITIONS.—In the section: 
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‘‘(1) ALZHEIMER’S DISEASE.—The term ‘Alz-
heimer’s disease’ means Alzheimer’s disease and re-
lated dementias. 
‘‘(2) INDIAN TRIBE; TRIBAL ORGANIZATION.— 
The terms ‘Indian tribe’ and ‘tribal organization’ 
have the meanings given such terms in section 4 of 
the Indian Health Care Improvement Act. 
‘‘(b) EXPANSION OF ACTIVITIES UNDER THE ALZ-
HEIMER’S DISEASE AND HEALTHY AGING PROGRAM.—In 
addition to activities conducted by the Secretary under the 
Alzheimer’s Disease and Healthy Aging Program of the 
Centers for Disease Control and Prevention, the Sec-
retary, acting through the Director of the Centers for Dis-
ease Control and Prevention, subject to appropriations 
under subsection (g), shall award cooperative agreements 
under subsections (c), (d), and (e). 
‘‘(c) CENTERS OF EXCELLENCE IN PUBLIC HEALTH 
PRACTICE.— 
‘‘(1) IN GENERAL.—The Secretary shall award 
cooperative agreements to eligible entities for the es-
tablishment or support of national or regional cen-
ters of excellence in public health practice in Alz-
heimer’s disease to— 
‘‘(A) advance the education of public 
health officials of States, of political subdivi-
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sions of States, and of Indian tribes or tribal 
organizations, health care professionals, and the 
public on Alzheimer’s disease, cognitive decline, 
brain health, and associated health disparities; 
‘‘(B) advance the efforts of public health 
officials referred to in subparagraph (A) in ap-
plying evidence-based systems change, commu-
nications, and programmatic interventions for 
populations with cognitive impairment, includ-
ing Alzheimer’s disease, and caregivers for such 
populations; and 
‘‘(C) expand public-private partnerships 
engaged in activities related to cognitive impair-
ment and associated health disparities with 
demonstrated success or innovative programs 
(as determined by the Secretary). 
‘‘(2) REQUIREMENTS.—To be eligible to receive 
a cooperative agreement under this subsection, an 
entity shall submit to the Secretary an application 
containing such agreements and information as the 
Secretary may require, including an agreement that 
the center to be established or supported under the 
cooperative agreement will operate in accordance 
with the following: 
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‘‘(A) The center will examine, evaluate, in-
crease, and promote evidence-based and effec-
tive Alzheimer’s disease and caregiving-related 
interventions for health and social services pro-
fessionals, underserved populations, families, 
and the public, after consultation with relevant 
State and local public health officials, private- 
sector Alzheimer’s disease researchers, and ad-
vocates for individuals with Alzheimer’s disease. 
‘‘(B) The center will prioritize its activities 
on the following: 
‘‘(i) Expanding efforts to educate 
State, local, and tribal officials and public 
health professionals in applying established 
data and evidence-based best practices to 
address Alzheimer’s disease. 
‘‘(ii) Supporting public health officials 
of States, of political subdivisions of 
States, and of Indian tribes or tribal orga-
nizations in implementing the most current 
version of the ‘Healthy Brain Initiative: 
Public Health Road Map’ of the Centers 
for Disease Control and Prevention. 
‘‘(iii) Supporting early detection and 
diagnosis of Alzheimer’s disease. 
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‘‘(iv) Reducing the risk of potentially 
avoidable hospitalizations of individuals 
with Alzheimer’s disease. 
‘‘(v) Reducing the risk of cognitive de-
cline and cognitive impairment, including 
Alzheimer’s disease. 
‘‘(vi) Enhancing support to meet the 
needs of caregivers of individuals with Alz-
heimer’s disease. 
‘‘(vii) Reducing health disparities re-
lated to the care and support of individuals 
with cognitive decline and Alzheimer’s dis-
ease. 
‘‘(viii) Supporting care planning and 
management for individuals with Alz-
heimer’s disease. 
‘‘(3) CONSIDERATIONS.—In awarding coopera-
tive agreements under this subsection, the Secretary 
shall consider, among other factors, whether the en-
tity— 
‘‘(A) has access to rural areas or other un-
derserved populations; 
‘‘(B) is located in an area where the aggre-
gate success rate for applications for National 
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Institutes of Health funding has been histori-
cally low; 
‘‘(C) is able to build on an existing infra-
structure of service and public health research; 
‘‘(D) has experience with providing care, 
caregiver support, and research related to Alz-
heimer’s disease; and 
‘‘(E) is integrated into existing local gov-
ernment and public health infrastructures. 
‘‘(4) DISTRIBUTION OF AWARDS.—In awarding 
cooperative agreements under this subsection, the 
Secretary, to the extent practicable, shall ensure eq-
uitable distribution of awards based on geographic 
area, including consideration of rural areas, and the 
burden of the disease on sub-populations. 
‘‘(d) 
COOPERATIVE
AGREEMENTS
TO
PUBLIC 
HEALTH DEPARTMENTS.— 
‘‘(1) IN GENERAL.—The Secretary shall award 
cooperative agreements to health departments of 
States, of political subdivisions of States, and of In-
dian tribes and tribal organizations to promote cog-
nitive functioning, address cognitive impairment for 
individuals living in such communities, help meet the 
needs of caregivers, and address unique aspects of 
Alzheimer’s disease, as follows: 
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‘‘(A) The Secretary shall award core ca-
pacity cooperative agreements to such health 
departments to support the development and 
implementation of systems change, communica-
tions, and programmatic interventions with re-
spect to Alzheimer’s disease, including activities 
involving— 
‘‘(i) educating and informing the pub-
lic based on established public health re-
search and data; 
‘‘(ii) supporting early detection and 
diagnosis; 
‘‘(iii) reducing the risk of potentially 
avoidable hospitalizations; 
‘‘(iv) reducing the risk of cognitive de-
cline and cognitive impairment; 
‘‘(v) enhancing support to meet the 
needs of caregivers; 
‘‘(vi) supporting care planning and 
management; or 
‘‘(vii) supporting the actions set forth 
in the most current version of the ‘Healthy 
Brain Initiative: Public Health Road Map’ 
of the Centers for Disease Control and 
Prevention. 
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‘‘(B) The Secretary shall award not less 
than 5 enhanced activity cooperative agree-
ments to such health departments to carry out 
activities related to Alzheimer’s disease, includ-
ing through public-private partnerships with or-
ganizations or other agencies, such as large em-
ployers, public housing agencies, large health 
care systems, and parks and recreation depart-
ments, that include— 
‘‘(i) expanding implementation of pro-
grams described in paragraph (2)(A) to 
reach larger segments of the population; 
and 
‘‘(ii) implementing the reports de-
scribed in subparagraph (A)(vii). 
‘‘(2) OTHER CONSIDERATIONS.— 
‘‘(A) PREFERENCE.—In awarding coopera-
tive agreements under paragraph (1), the Sec-
retary shall give preference to applications that 
focus on addressing health disparities, including 
populations and geographic areas that are most 
in need of intervention. 
‘‘(B) CLARIFICATION
ON
ENHANCED
AC-
TIVITY
COOPERATIVE
AGREEMENTS.—If the 
Secretary is unable to identify 5 eligible health 
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departments to receive a cooperative agreement 
under paragraph (1)(B), the Secretary shall al-
locate any amounts reserved for such agree-
ments to additional cooperative agreements 
under paragraph (1)(A). 
‘‘(3) ELIGIBILITY.—To be eligible to receive a 
cooperative agreement under paragraph (1), a State, 
political subdivision of a State, Indian tribe, or tribal 
organization shall prepare and submit to the Sec-
retary an application at such time, in such manner, 
and containing such information as the Secretary 
may require, including a plan that describes— 
‘‘(A) how the applicant proposes to develop 
or expand, programs to educate individuals 
through partnership engagement, workforce de-
velopment, guidance and support for pro-
grammatic efforts, strategic communication, 
and evaluation with respect to Alzheimer’s dis-
ease, and in the case of a cooperative agree-
ment under paragraph (1)(B), how the appli-
cant proposes to implement the most current 
version of the ‘Healthy Brain Initiative: Public 
Health Road Map’ of the Centers for Disease 
Control and Prevention; 
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‘‘(B) the manner in which the applicant 
will coordinate with appropriate State and local 
authorities as well as, in the case of a coopera-
tive agreement under paragraph (1)(B), rel-
evant public and private organizations or agen-
cies; and 
‘‘(C) the manner in which the applicant 
will evaluate the effectiveness of any program 
carried out under the cooperative agreement. 
‘‘(4) USE
OF
FUNDS.—A health department 
awarded a cooperative agreement under paragraph 
(1) shall use amounts received under such coopera-
tive agreement to— 
‘‘(A) 
develop, 
implement, 
disseminate, 
evaluate, and if applicable, expand programs to 
educate individuals on matters related to Alz-
heimer’s disease described in paragraph (1)(A); 
and 
‘‘(B) in the case of a cooperative agree-
ment under paragraph (1)(B), implement the 
most current version of the ‘Healthy Brain Ini-
tiative: Public Health Road Map’ of the Centers 
for Disease Control and Prevention and evalu-
ate its implementation. 
‘‘(5) MATCHING REQUIREMENT.— 
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‘‘(A) IN GENERAL.—Except as may be pro-
vided in subparagraph (B), each health depart-
ment that is awarded a cooperative agreement 
under paragraph (1) shall provide, from non- 
Federal sources, an amount equal to 15 percent 
of the amount provided under such agreement 
(which may be provided in cash or in-kind) to 
carry out the activities supported by the cooper-
ative agreement. 
‘‘(B) WAIVER AUTHORITY.—The Secretary 
may waive all or part of the matching require-
ment described in subparagraph (A) for any fis-
cal year for— 
‘‘(i) a health department, if the Sec-
retary determines that applying such 
matching requirement to the health depart-
ment would result in serious hardship or 
an inability to carry out the purposes of 
the cooperative agreement awarded to such 
health department; or 
‘‘(ii) a rural or frontier region. 
‘‘(e) COOPERATIVE AGREEMENTS FOR ANALYSIS AND 
REPORTING OF DATA REGARDING COGNITIVE DECLINE 
AND CAREGIVING.— 
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‘‘(1) IN GENERAL.—The Secretary may award 
cooperative agreements to eligible entities for the fol-
lowing activities: 
‘‘(A) The analysis and timely public re-
porting of data on the State and national levels 
regarding cognitive decline, including Alz-
heimer’s disease, caregiving, and health dispari-
ties experienced by individuals with cognitive 
decline and their caregivers. 
‘‘(B) The monitoring of objectives on de-
mentia, including Alzheimer’s disease, and 
caregiving in the program of the Secretary re-
garding health-status goals for 2020 (commonly 
referred to as the ‘Healthy People 2020 re-
port’), and the development and monitoring of 
such objectives in future Healthy People reports 
of the Department of Health and Human Serv-
ices. 
‘‘(2) ELIGIBILITY.—To be eligible to receive a 
cooperative agreement under this subsection, an en-
tity shall be a public or nonprofit private entity, in-
cluding institutions of higher education, and submit 
to the Secretary an application at such time, in such 
manner, and containing such information as the Sec-
retary may require. 
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‘‘(3) SURVEILLANCE.—The analysis, timely 
public reporting, and dissemination of data regard-
ing cognitive decline, cognitive impairment, caregiv-
ing, and health disparities on the State and national 
levels under a cooperative agreement under this sub-
section may be carried out by eligible entities using 
data sources such as the following: 
‘‘(A) The Behavioral Risk Factor Surveil-
lance System. 
‘‘(B) The National Health and Nutrition 
Examination Survey. 
‘‘(C) The National Health Interview Sur-
vey. 
‘‘(f) DATA COLLECTION.—The Secretary shall collect 
data on cognitive decline, cognitive impairment, caregiv-
ing, and health disparities on the State and national levels, 
using the surveillance systems described in subparagraphs 
(A) through (C) of subsection (e)(3). 
‘‘(g) NONDUPLICATION OF EFFORT.—The Secretary 
shall ensure that activities under any cooperative agree-
ment awarded under this section do not unnecessarily du-
plicate efforts of other agencies and offices within the De-
partment of Health and Human Services related to— 
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‘‘(1) activities of centers of excellence in public 
health practice with respect to Alzheimer’s disease 
described in subsection (c); 
‘‘(2) activities of public health departments with 
respect to Alzheimer’s disease described in sub-
section (d); or 
‘‘(3) the analysis and public reporting of sur-
veillance data on cognitive decline, caregiving, and 
health disparities of individuals with Alzheimer’s dis-
ease under subsection (e). 
‘‘(h) AUTHORIZATION
OF APPROPRIATIONS.—For 
each of fiscal years 2018 through 2025, there are author-
ized to be appropriated $12,000,000 for purposes of car-
rying out subsection (c), $20,000,000 for purposes of car-
rying out subsection (d), and $5,000,000 for purposes of 
carrying out subsections (e) and (f). Funds appropriated 
under this subsection shall remain available until ex-
pended.’’. 
Æ 
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