Title: BOLD Infrastructure for Alzheimer's Act
Policy area: Health

Summary:
Building Our Largest Dementia Infrastructure for Alzheimer's Act or the BOLD Infrastructure for Alzheimer's Act
This bill requires the Department of Health and Human Services to award cooperative agreements to state and local health departments to expand activities related to Alzheimer's disease, including activities involving early detection, support for caregivers, and public awareness.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4256 Introduced in House (IH)]

<DOC>






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, cognitive decline, and brain 
health under the Alzheimer's Disease and Healthy Aging Program, and for 
                            other purposes.

    Be it enacted by the Senate and House of Representatives 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''.

SEC. 2. FINDINGS.

    Congress finds as follows:
            (1) According to former Surgeon General and Director of the 
        Centers for Disease Control and Prevention, 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 Disease Control and Prevention.
            (3) More than 5,000,000 people in the United States are 
        living with Alzheimer's disease and, without significant 
        efforts to change the current trajectory, 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 
        Alzheimer'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 disease, only 33 percent are aware of the 
        diagnosis. Early detection and diagnosis of Alzheimer's disease 
        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 comorbid 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 disease and other 
        dementias. Hispanics are about one and one-half times more 
        likely than White Americans to have Alzheimer's disease and 
        other dementias.
            (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 impact of 
        caregiving of individuals with Alzheimer's disease and other 
        dementia resulted in an estimated $10,900,000,000 in increased 
        caregiver health costs in 2016.
            (8) Strategy 4.B of the ``National Plan to Address 
        Alzheimer's Disease: 2017 Update'' of the Office 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, COGNITIVE 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 KNOWLEDGE AND AWARENESS OF 
              ALZHEIMER'S DISEASE, COGNITIVE DECLINE, AND BRAIN HEALTH 
              UNDER THE ALZHEIMER'S DISEASE AND HEALTHY AGING PROGRAM.

    ``(a) Definitions.--In the section:
            ``(1) Alzheimer's disease.--The term `Alzheimer's disease' 
        means Alzheimer's disease and related 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 Alzheimer'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 Secretary, acting 
through the Director of the Centers for Disease 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 establishment or 
        support of national or regional centers of excellence in public 
        health practice in Alzheimer's disease to--
                    ``(A) advance the education of public health 
                officials of States, of political subdivisions 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 applying 
                evidence-based systems change, communications, and 
                programmatic interventions for populations with 
                cognitive impairment, including Alzheimer's disease, 
                and caregivers for such populations; and
                    ``(C) expand public-private partnerships engaged in 
                activities related to cognitive impairment 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:
                    ``(A) The center will examine, evaluate, increase, 
                and promote evidence-based and effective Alzheimer's 
                disease and caregiving-related interventions for health 
                and social services professionals, underserved 
                populations, families, and the public, after 
                consultation with relevant State and local public 
                health officials, private-sector Alzheimer's disease 
                researchers, and advocates 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 organizations 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.
                            ``(iv) Reducing the risk of potentially 
                        avoidable hospitalizations of individuals with 
                        Alzheimer's disease.
                            ``(v) Reducing the risk of cognitive 
                        decline and cognitive impairment, including 
                        Alzheimer's disease.
                            ``(vi) Enhancing support to meet the needs 
                        of caregivers of individuals with Alzheimer's 
                        disease.
                            ``(vii) Reducing health disparities related 
                        to the care and support of individuals with 
                        cognitive decline and Alzheimer's disease.
                            ``(viii) Supporting care planning and 
                        management for individuals with Alzheimer's 
                        disease.
            ``(3) Considerations.--In awarding cooperative agreements 
        under this subsection, the Secretary shall consider, among 
        other factors, whether the entity--
                    ``(A) has access to rural areas or other 
                underserved populations;
                    ``(B) is located in an area where the aggregate 
                success rate for applications for National Institutes 
                of Health funding has been historically low;
                    ``(C) is able to build on an existing 
                infrastructure of service and public health research;
                    ``(D) has experience with providing care, caregiver 
                support, and research related to Alzheimer's disease; 
                and
                    ``(E) is integrated into existing local government 
                and public health infrastructures.
            ``(4) Distribution of awards.--In awarding cooperative 
        agreements under this subsection, the Secretary, to the extent 
        practicable, shall ensure equitable 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 Indian tribes and tribal 
        organizations to promote cognitive 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:
                    ``(A) The Secretary shall award core capacity 
                cooperative agreements to such health departments to 
                support the development and implementation of systems 
                change, communications, and programmatic interventions 
                with respect to Alzheimer's disease, including 
                activities involving--
                            ``(i) educating and informing the public 
                        based on established public health research and 
                        data;
                            ``(ii) supporting early detection and 
                        diagnosis;
                            ``(iii) reducing the risk of potentially 
                        avoidable hospitalizations;
                            ``(iv) reducing the risk of cognitive 
                        decline 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.
                    ``(B) The Secretary shall award not less than 5 
                enhanced activity cooperative agreements to such health 
                departments to carry out activities related to 
                Alzheimer's disease, including through public-private 
                partnerships with organizations or other agencies, such 
                as large employers, public housing agencies, large 
                health care systems, and parks and recreation 
                departments, that include--
                            ``(i) expanding implementation of programs 
                        described in paragraph (2)(A) to reach larger 
                        segments of the population; and
                            ``(ii) implementing the reports described 
                        in subparagraph (A)(vii).
            ``(2) Other considerations.--
                    ``(A) Preference.--In awarding cooperative 
                agreements under paragraph (1), the Secretary 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 activity 
                cooperative agreements.--If the Secretary is unable to 
                identify 5 eligible health departments to receive a 
                cooperative agreement under paragraph (1)(B), the 
                Secretary shall allocate any amounts reserved for such 
                agreements 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 Secretary 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 development, guidance 
                and support for programmatic efforts, strategic 
                communication, and evaluation with respect to 
                Alzheimer's disease, and in the case of a cooperative 
                agreement under paragraph (1)(B), how the applicant 
                proposes to implement the most current version of the 
                `Healthy Brain Initiative: Public Health Road Map' of 
                the Centers for Disease Control and Prevention;
                    ``(B) the manner in which the applicant will 
                coordinate with appropriate State and local authorities 
                as well as, in the case of a cooperative agreement 
                under paragraph (1)(B), relevant public and private 
                organizations or agencies; 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 cooperative agreement to--
                    ``(A) develop, implement, disseminate, evaluate, 
                and if applicable, expand programs to educate 
                individuals on matters related to Alzheimer's disease 
                described in paragraph (1)(A); and
                    ``(B) in the case of a cooperative agreement under 
                paragraph (1)(B), implement the most current version of 
                the `Healthy Brain Initiative: Public Health Road Map' 
                of the Centers for Disease Control and Prevention and 
                evaluate its implementation.
            ``(5) Matching requirement.--
                    ``(A) In general.--Except as may be provided in 
                subparagraph (B), each health department 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 cooperative 
                agreement.
                    ``(B) Waiver authority.--The Secretary may waive 
                all or part of the matching requirement described in 
                subparagraph (A) for any fiscal year for--
                            ``(i) a health department, if the Secretary 
                        determines that applying such matching 
                        requirement to the health department 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.--
            ``(1) In general.--The Secretary may award cooperative 
        agreements to eligible entities for the following activities:
                    ``(A) The analysis and timely public reporting of 
                data on the State and national levels regarding 
                cognitive decline, including Alzheimer's disease, 
                caregiving, and health disparities experienced by 
                individuals with cognitive decline and their 
                caregivers.
                    ``(B) The monitoring of objectives on dementia, 
                including Alzheimer's disease, and caregiving in the 
                program of the Secretary regarding health-status goals 
                for 2020 (commonly referred to as the `Healthy People 
                2020 report'), and the development and monitoring of 
                such objectives in future Healthy People reports of the 
                Department of Health and Human Services.
            ``(2) Eligibility.--To be eligible to receive a cooperative 
        agreement under this subsection, an entity shall be a public or 
        nonprofit private entity, including institutions of higher 
        education, and submit to the Secretary an application at such 
        time, in such manner, and containing such information as the 
        Secretary may require.
            ``(3) Surveillance.--The analysis, timely public reporting, 
        and dissemination of data regarding cognitive decline, 
        cognitive impairment, caregiving, and health disparities on the 
        State and national levels under a cooperative agreement under 
        this subsection may be carried out by eligible entities using 
        data sources such as the following:
                    ``(A) The Behavioral Risk Factor Surveillance 
                System.
                    ``(B) The National Health and Nutrition Examination 
                Survey.
                    ``(C) The National Health Interview Survey.
    ``(f) Data Collection.--The Secretary shall collect data on 
cognitive decline, cognitive impairment, caregiving, 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 agreement awarded under this section 
do not unnecessarily duplicate efforts of other agencies and offices 
within the Department of Health and Human Services related to--
            ``(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 subsection (d); or
            ``(3) the analysis and public reporting of surveillance 
        data on cognitive decline, caregiving, and health disparities 
        of individuals with Alzheimer's disease under subsection (e).
    ``(h) Authorization of Appropriations.--For each of fiscal years 
2018 through 2025, there are authorized to be appropriated $12,000,000 
for purposes of carrying out subsection (c), $20,000,000 for purposes 
of carrying 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 expended.''.
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