I 
116TH CONGRESS 
1ST SESSION H. R. 2283 
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 
APRIL 10, 2019 
Ms. SA´NCHEZ (for herself, Mr. LAHOOD, Ms. MATSUI, and Mrs. RODGERS of 
Washington) 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 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, 
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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 Act of 2019’’ or the ‘‘CHANGE Act of 2019’’. 
(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. Medicare quality payment program. 
Sec. 4. Report to Congress on implementation of this Act. 
Sec. 5. 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) It is estimated that 5.8 million Americans 
are living with Alzheimer’s disease in 2019. This in-
cludes an estimated 5.6 million people age 65 and 
older and approximately 200,000 individuals under 
age 65 who have younger-onset Alzheimer’s. By 
2050, the number of people age 65 and older with 
Alzheimer’s dementia is projected to increase to 13.8 
million Americans. 
(2) As many as half of the estimated 5,100,000 
American seniors with Alzheimer’s disease and other 
dementias have never received a diagnosis. 
(3) In 2019, it is estimated that Alzheimer’s 
and related dementias will have cost the Medicare 
and Medicaid programs $195 billion. By 2050, it is 
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estimated that these direct costs will increase to as 
much as $1.1 trillion. 
(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. 
(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. According to the Centers for Disease Control 
and Prevention, among people ages 65 and older, 
African Americans have the highest prevalence of 
Alzheimer’s disease and related dementias (13.8 per-
cent), followed by Hispanics (12.2 percent), and 
non-Hispanic Whites (10.3 percent), American In-
dian and Alaska Natives (9.1 percent), and Asian 
and Pacific Islanders (8.4 percent). This higher 
prevalence translates into a higher death rate: Alz-
heimer’s deaths increased 55 percent among all 
Americans between 1999 and 2014, while the num-
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ber was 107 percent for Latinos and 99 percent for 
African Americans. 
(6) There are evidence-based, reliable, and 
NIH-identified cognitive impairment detection tools 
available at the National Institute on Aging’s Alz-
heimer’s and Dementia Resources for Professionals 
website that must replace detection by direct obser-
vation in the Medicare Annual visits and Welcome to 
Medicare visits. The NIH-identified tools will allow 
for appropriate follow-up instead of delaying diag-
nosis or impeding opportunities for patients to ac-
cess timely treatment options, including clinical trial 
participation. 
(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) African Americans represent 13 percent of 
the population of the United States but only 5 per-
cent of clinical trial participants, and Latinos rep-
resent 17 percent of the population of the United 
States but less than one percent of clinical trial par-
ticipants. Further, Latinos and African Americans 
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account for only 3.5 percent and 1.2 percent, respec-
tively, of principal investigators supported by the 
National Institutes of Health funding, limiting this 
perspective in research. Better recruitment and trial 
designs are critical to addressing innovation in Alz-
heimer’s generally, including the underrepresentation 
of African Americans and Latinos. 
(9) Inability to identify eligible patients at the 
earliest stages of disease is a substantial impediment 
to efficient research toward Alzheimer’s disease pre-
vention, treatment, and cure. 
(10) Advancing treatment options to prevent, 
treat, or cure Alzheimer’s is an urgent national pri-
ority. 
(11) A paradigm shift to drive synergies be-
tween high-value patient care, caregiver support, 
brain health promotion, and research initiatives is 
our best hope for preventing, treating, and curing 
Alzheimer’s disease. 
SEC. 2. COGNITIVE IMPAIRMENT DETECTION BENEFIT IN 
THE MEDICARE ANNUAL WELLNESS VISIT 
AND INITIAL PREVENTIVE PHYSICAL EXAM-
INATION. 
(a) ANNUAL WELLNESS VISIT.— 
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