Concentrating on High-Value Alzheimer’s Needs to Get to an End (CHANGE) Act of 2021
Bill: S.1692 | Sponsor: Sen. Capito, Shelley Moore (R-WV)
Policy area: Health

Summary:
Concentrating on High-value Alzheimer's Needs to Get to an End (CHANGE) Act of 2021  This bill modifies the requirements under Medicare for diagnosing and treating Alzheimer's disease and other cognitive impairments in older adults. Specifically, the bill expands the cognitive impairment detection benefit during annual wellness visits to require the use of validated detection tools and documentation of the results in the patient's medical record. Further, when a cognitive impairment is detected, the patient must be referred to an appropriate diagnostic service provider and other specified supports.  Additionally, the Centers for Medicare & Medicaid Services must implement Medicare policies that increase the identification and response to patients' Alzheimer's disease risk factors and incentivize providers to utilize high-quality cognitive impairment diagnosis practices.

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 Representatives 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 2021''.
    (b) Table of Contents.--The table of contents for 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.
    (c) Findings.--Congress finds the following:
            (1) It is estimated that 6,200,000 Americans age 65 and 
        older are living with Alzheimer's disease in 2021. More than 1 
        in 9 people age 65 and older has Alzheimer's. By 2050, the 
        number of Americans age 65 and older with Alzheimer's dementia 
        is projected to reach 12,700,000.
            (2) Alzheimer's disease disproportionately impacts women 
        and people of color.
            (3) Almost two-thirds of Americans with Alzheimer's disease 
        are women.
            (4) 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 percent), followed by Hispanics (12.2 percent), 
        and non-Hispanic Whites (10.3 percent), American Indian and 
        Alaska Natives (9.1 percent), and Asian and Pacific Islanders 
        (8.4 percent). 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 percent for African Americans.
            (5) Currently available data shows that about half of 
        individuals age 65 and older with mild cognitive impairment 
        (MCI)--roughly 5,000,000 Americans--have MCI due to Alzheimer's 
        disease. Approximately 15 percent of individuals with MCI 
        develop dementia after 2 years and 32 percent develop 
        Alzheimer's dementia within 5 years' follow-up.
            (6) Addressing modifiable risk factors such as physical 
        activity, smoking, education, staying socially and mentally 
        active, blood pressure, and diet might prevent or delay up to 
        40 percent of dementia cases.
            (7) An early, documented diagnosis, communicated to the 
        patient and caregiver, enables early access to care planning 
        services and available medical and nonmedical treatments, and 
        optimizes patients' ability to build a care team, participate 
        in support services, and enroll in clinical trials.
            (8) Alzheimer's exacts an emotional and physical toll on 
        caregivers, resulting in higher incidence of heart disease, 
        cancer, depression, and other health consequences.
            (9) More than 11,000,000 Americans provide unpaid care for 
        people with Alzheimer's or other dementia and provided nearly 
        $257,000,000,000 in unpaid care to people living with 
        Alzheimer's and other dementias in 2020.
            (10) In 2021, it is estimated that Alzheimer's and related 
        dementias will have cost Medicare and Medicaid programs 
        $239,000,000,000. By 2050, it is estimated that these direct 
        costs will increase to as much as $1,100,000,000,000.

SEC. 2. COGNITIVE IMPAIRMENT DETECTION BENEFIT IN THE MEDICARE ANNUAL 
              WELLNESS VISIT AND INITIAL PREVENTIVE PHYSICAL 
              EXAMINATION.

    (a) Annual Wellness Visit.--
            (1) In general.--Section 1861(hhh)(2) of the Social 
        Security Act (42 U.S.C. 1395x(hhh)(2)) is amended--
                    (A) by striking subparagraph (D) and inserting the 
                following:
            ``(D) Detection of any cognitive impairment or progression 
        of cognitive impairment that shall--
            ``(i) be performed using a cognitive impairment detection 
        tool identified by the National Institute on Aging as meeting 
        its criteria for selecting instruments to detect cognitive 
        impairment in the primary care setting, and other validated 
        cognitive detection tools as the Secretary determines;
            ``(ii) include documentation of the tool used for detecting 
        cognitive impairment and results of the assessment in the 
        medical record of the patient; and
            ``(iii) take into consideration the tool used, and results 
        of, any previously performed cognitive impairment detection 
        assessment.'';
                    (B) by moving subparagraphs (G) and (H) two ems to 
                the left;
                    (C) by redesignating subparagraph (I) as 
                subparagraph (J); and
                    (D) by inserting after subparagraph (H) the 
                following new subparagraph:
            ``(I) Referral of patients with detected cognitive 
        impairment or potential cognitive decline to--
                    ``(i) appropriate Alzheimer's disease and dementia 
                diagnostic services, including amyloid positron 
                emission tomography, and other medically accepted 
                diagnostic tests that the Secretary determines are safe 
                and effective;
                    ``(ii) specialists and other clinicians with 
                expertise in diagnosing or treating Alzheimer's disease 
                and related dementias;
                    ``(iii) available community-based services, 
                including patient and caregiver counseling and social 
                support services; and
                    ``(iv) appropriate clinical trials.''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply to annual wellness visits furnished on or after 
        January 1, 2022.
    (b) Initial Preventive Physical Examination.--
            (1) In general.--Section 1861(ww)(1) of the Social Security 
        Act (42 U.S.C. 1395x(ww)(1)) is amended by inserting 
        ``detection of any cognitive impairment or progression of 
        cognitive impairment as described in subparagraph (D) of 
        subsection (hhh)(2) and referrals as described in subparagraph 
        (I) of such subsection,'' after ``upon the agreement with the 
        individual,''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply to initial preventive physical examinations 
        furnished on or after January 1, 2022.

SEC. 3. MEDICARE QUALITY PAYMENT PROGRAM.

    Not later than January 1, 2022, the Secretary of Health and Human 
Services shall implement Medicare policies under title XVIII of the 
Social Security Act (42 U.S.C. 1395 et seq.), including quality 
measures and Medicare Advantage plan rating and risk adjustment 
mechanisms, that reflect the public health imperative of--
            (1) promoting healthy brain lifestyle choices;
            (2) identifying and responding to patient risk factors for 
        Alzheimer's disease and related dementias; and
            (3) incentivizing providers for--
                    (A) adequate and reliable cognitive impairment 
                detection in the primary care setting, that is 
                documented in the electronic health record of the 
                patient and communicated to the patient;
                    (B) timely Alzheimer's disease diagnosis; and
                    (C) appropriate care planning services, including 
                identification of, and communication with patients and 
                caregivers regarding, the potential for clinical trial 
                participation.

SEC. 4. REPORT TO CONGRESS ON IMPLEMENTATION.

    Not later than 3 years after the date of the enactment of this Act, 
the Secretary of Health and Human Services shall submit to Congress a 
report on the implementation of the provisions of, and amendments made 
by, this Act, including--
            (1) the increased use of validated tools for detection of 
        cognitive impairment and Alzheimer's disease;
            (2) utilization of Alzheimer's disease diagnostic and care 
        planning services; and
            (3) outreach efforts in the primary care and patient 
        communities.
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