II 118th CONGRESS 1st Session S. 2379 IN THE SENATE OF THE UNITED STATES July 19, 2023 Mrs. Capito (for herself, Ms. Stabenow , Mr. Menendez , and Mr. Wicker ) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XVIII of the Social Security Act to provide for certain cognitive impairment detection in the Medicare annual wellness visit and initial preventive physical examination.

1. Short title This Act may be cited as the Concentrating on High-value Alzheimer's Needs to Get to an End Act of 2023 or the CHANGE Act of 2023 . 2. Findings Congress finds the following: (1) It is estimated that 6.7 million Americans are living with Alzheimer’s disease, a number that is estimated to rise to nearly 13.8 million by 2060. About 1 in 9 people age 65 and older have Alzheimer's. (2) Older Black Americans are twice as likely, and Latino Americans are 1.5 times as likely, to have Alzheimer's disease than older White Americans. Nearly two-thirds of Americans with Alzheimer's disease are women. (3) In 2021, Alzheimer's disease was the seventh-leading cause of death in the United States. (4) Addressing modifiable risk factors for Alzheimer's and other types of dementia such as hypertension, physical inactivity, smoking, depression, diabetes, obesity, and poor nutrition might prevent or delay up to 40 percent of dementia cases. In 2021 the National Plan to Address Alzheimer's disease was updated to include a new goal to focus on reducing risk of developing dementia. (5) An early documented diagnosis communicated to the patient and caregiver enables early access to care planning services and available medical and non-medical treatments and optimizes patients' ability to build a care team, participate in support services, and enroll in clinical trials. (6) Alzheimer's exacts an emotional and physical toll on caregivers, resulting in higher incidence of heart disease, cancer, depression, and other health consequences. (7) More than 11 million Americans provide unpaid care for people with Alzheimer's or other dementia and provided nearly $340 billion in unpaid care to people living with Alzheimer's and other dementia in 2022. (8) In 2023, it is estimated that Alzheimer's and related dementia will cost our nation $345 billion, not including the value of unpaid caregiving. By 2050, it is estimated that these direct costs will increase to nearly $1 trillion. 3. 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 by striking subparagraph (D) and inserting the following: (D) Detection of any cognitive impairment that shall— (i) be performed using one of the cognitive impairment detection tools identified by the National Institute on Aging as meeting its criteria for selecting instruments to detect cognitive impairment in the primary care setting; and (ii) include documentation of the tool used for detecting cognitive impairment and results of the assessment in the patient's medical record. . (2) Effective date The amendment made by paragraph (1) shall apply to annual wellness visits furnished on or after January 1, 2024. (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 striking agreement with the individual, and and inserting agreement with the individual, detection of any cognitive impairment as described in subsection (hhh)(2)(D), and . (2) Effective date The amendment made by paragraph (1) shall apply to initial preventive physical examinations furnished on or after January 1, 2024.