Title: Concentrating on High-value Alzheimer’s Needs to Get to an End (CHANGE) Act of 2019
Policy area: Health

Summary:
Concentrating on High-value Alzheimer's Needs to Get to an End (CHANGE) Act of 2019  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 and 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.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 1126 Introduced in Senate (IS)]

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116th CONGRESS
  1st Session
                                S. 1126

     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 SENATE OF THE UNITED STATES

                             April 10, 2019

 Mrs. Capito (for herself, Ms. Stabenow, Mr. Wicker, and Mr. Menendez) 
introduced the following bill; which was read twice and referred to the 
                          Committee on Finance

_______________________________________________________________________

                                 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 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 2019''.
    (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 5,800,000 million Americans are 
        living with Alzheimer's disease in 2019. This includes an 
        estimated 5,600,000 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 
        13,800,000 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 expected that Alzheimer's and related 
        dementias will cost Medicare and Medicaid $195,000,000,000. By 
        2050, it is estimated that overall Alzheimer's costs will 
        increase to more than $1,100,000,000,000.
            (4) Alzheimer's exacts an emotional and physical toll on 
        caregivers, resulting in higher incidence of heart disease, 
        cancer, depression, and other health consequences.
            (5) Alzheimer's disease disproportionately impacts women 
        and people of color. Women are twice as likely to develop 
        Alzheimer's as they are breast cancer. African Americans are 
        about 2 times more likely than White Americans to have 
        Alzheimer's disease and other dementias. Latinos are about 1\1/
        2\ times more likely than White Americans to have Alzheimer's 
        disease and other dementias. According to the Centers for 
        Disease Control, 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.
            (6) The latest science reveals there are actions that can 
        be taken both now and across the lifespan of an individual to 
        help optimize brain health, reduce the risk of cognitive 
        decline, and help mitigate symptoms. There are also important 
        behavioral and social dimensions that could delay cognitive 
        decline and build a resilient brain. For example, a 2016 study 
        supported by the National Institutes of Health found that a 
        diet high in natural plant-based foods and limited in saturated 
        fats was associated with reduced cognitive decline. A 2017 
        study published by the Lancet Commission found that physical 
        activity had a significant protective effect against cognitive 
        decline. A study supported by the National Institutes of Health 
        which was published in 2018 found a connection between lower 
        blood pressure and decreased cognitive impairment. An American 
        Academy of Neurology study recently published found that 
        physical activity and cognitive activity were both associated 
        with reduced risk of total dementia.
            (7) There are evidence-based, reliable, and National 
        Institutes of Health-identified cognitive impairment detection 
        tools that are available on the Alzheimer's and Dementia 
        Resources website of the National Institute on Aging that must 
        replace detection by direct observation in the Medicare Annual 
        visits and Welcome to Medicare visits. The National Institutes 
        of Health-identified tools will allow for appropriate follow-up 
        instead of delaying diagnosis or impeding opportunities for 
        patients to access timely treatment options, including clinical 
        trial participation.
            (8) 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 the ability of patients to build a care team, 
        participate in support services, and enroll in clinical trials.
            (9) African Americans represent 13 percent of the United 
        States population, but only 5 percent of clinical trial 
        participants, and Latinos represent 17 percent of the United 
        States population, but less than 1 percent of clinical trial 
        participants. Further, Latinos and African Americans account 
        for only 3.5 percent and 1.2 percent, respectively, 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 Alzheimer's generally, including the 
        underrepresentation of African Americans and Latinos.
            (10) Inability to identify eligible patients at the 
        earliest stages of disease is a substantial impediment to 
        efficient research toward Alzheimer's disease prevention, 
        treatment, and cure.
            (11) Advancing treatment options to prevent, treat, or cure 
        Alzheimer's is an urgent national priority.
            (12) A paradigm shift to drive synergies between 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 
              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, 2020.
    (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, 2020.

SEC. 3. MEDICARE QUALITY PAYMENT PROGRAM.

    Not later than January 1, 2020, 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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