An act 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
PL 115-406 (S.2076), enacted 12/31/2018

132 STAT. 5362 
PUBLIC LAW 115–406—DEC. 31, 2018 
Public Law 115–406 
115th Congress 
An Act 
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. PROMOTION OF PUBLIC HEALTH KNOWLEDGE AND AWARE-
NESS OF ALZHEIMER’S DISEASE, COGNITIVE DECLINE, AND 
BRAIN HEALTH UNDER THE ALZHEIMER’S DISEASE AND 
HEALTHY AGING PROGRAM. 
Part K of title III of the Public Health Service Act (42 U.S.C. 
280c et seq.) is amended— 
(1) in the part heading, by adding ‘‘AND PUBLIC HEALTH 
PROGRAMS FOR DEMENTIA’’ at the end; and 
(2) in subpart II— 
(A) by striking the subpart heading and inserting the 
following: 
‘‘Subpart II—Programs With Respect to 
Alzheimer’s Disease and Related Dementias’’; and 
(B) by striking section 398A (42 U.S.C. 280c–4) and 
inserting the following: 
‘‘SEC. 398A. PROMOTION OF PUBLIC HEALTH KNOWLEDGE AND AWARE-
NESS OF ALZHEIMER’S DISEASE AND RELATED DEMEN-
TIAS. 
‘‘(a) ALZHEIMER’S DISEASE
AND RELATED DEMENTIAS PUBLIC 
HEALTH CENTERS OF EXCELLENCE.— 
‘‘(1) IN GENERAL.—The Secretary, in coordination with the 
Director of the Centers for Disease Control and Prevention 
and the heads of other agencies as appropriate, shall award 
grants, contracts, or cooperative agreements to eligible entities, 
such as institutions of higher education, State, tribal, and local 
health departments, Indian tribes, tribal organizations, associa-
tions, or other appropriate entities for the establishment or 
support of regional centers to address Alzheimer’s disease and 
related dementias by— 
Coordination. 
Grants. 
Contracts. 
42 USC 201 note. 
Building Our 
Largest 
Dementia 
Infrastructure for 
Alzheimer’s Act. 
Dec. 31, 2018 
[S. 2076] 
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132 STAT. 5363 
PUBLIC LAW 115–406—DEC. 31, 2018 
‘‘(A) advancing the awareness of public health officials, 
health care professionals, and the public, on the most cur-
rent information and research related to Alzheimer’s dis-
ease and related dementias, including cognitive decline, 
brain health, and associated health disparities; 
‘‘(B) identifying and translating promising research 
findings, such as findings from research and activities con-
ducted or supported by the National Institutes of Health, 
including Alzheimer’s Disease Research Centers authorized 
by section 445, into evidence-based programmatic interven-
tions for populations with Alzheimer’s disease and related 
dementias and caregivers for such populations; and 
‘‘(C) expanding activities, including through public-pri-
vate partnerships related to Alzheimer’s disease and 
related dementias and associated health disparities. 
‘‘(2) REQUIREMENTS.—To be eligible to receive a grant, con-
tract, or 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 a description of how the entity will— 
‘‘(A) coordinate, as applicable, with existing Federal, 
State, and tribal programs related to Alzheimer’s disease 
and related dementias; 
‘‘(B) examine, evaluate, and promote evidence-based 
interventions for individuals with Alzheimer’s disease and 
related dementias, including underserved populations with 
such conditions, and those who provide care for such 
individuals; and 
‘‘(C) prioritize activities relating to— 
‘‘(i) expanding efforts, as appropriate, to implement 
evidence-based practices to address Alzheimer’s disease 
and related dementias, including through the training 
of State, local, and tribal public health officials and 
other health professionals on such practices; 
‘‘(ii) supporting early detection and diagnosis of 
Alzheimer’s disease and related dementias; 
‘‘(iii) reducing the risk of potentially avoidable hos-
pitalizations of individuals with Alzheimer’s disease 
and related dementias; 
‘‘(iv) reducing the risk of cognitive decline and 
cognitive impairment associated with Alzheimer’s dis-
ease and related dementias; 
‘‘(v) enhancing support to meet the needs of care-
givers of individuals with Alzheimer’s disease and 
related dementias; 
‘‘(vi) reducing health disparities related to the care 
and support of individuals with Alzheimer’s disease 
and related dementias; 
‘‘(vii) supporting care planning and management 
for individuals with Alzheimer’s disease and related 
dementias; and 
‘‘(viii) supporting other relevant activities identi-
fied by the Secretary or the Director of the Centers 
for Disease Control and Prevention, as appropriate. 
‘‘(3) CONSIDERATIONS.—In awarding grants, contracts, and 
cooperative agreements under this subsection, the Secretary 
shall consider, among other factors, whether the entity— 
Application. 
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132 STAT. 5364 
PUBLIC LAW 115–406—DEC. 31, 2018 
‘‘(A) provides services to rural areas or other under-
served populations; 
‘‘(B) is able to build on an existing infrastructure of 
services and public health research; and 
‘‘(C) has experience with providing care or caregiver 
support, or has experience conducting research related to 
Alzheimer’s disease and related dementias. 
‘‘(4) DISTRIBUTION OF AWARDS.—In awarding grants, con-
tracts, or cooperative agreements under this subsection, the 
Secretary, to the extent practicable, shall ensure equitable dis-
tribution of awards based on geographic area, including consid-
eration of rural areas, and the burden of the disease within 
sub-populations. 
‘‘(5) DATA
REPORTING
AND
PROGRAM
OVERSIGHT.—With 
respect to a grant, contract, or cooperative agreement awarded 
under this subsection, not later than 90 days after the end 
of the first year of the period of assistance, and annually 
thereafter for the duration of the grant, contract, or agreement 
(including the duration of any renewal period as provided for 
under paragraph (5)), the entity shall submit data, as appro-
priate, to the Secretary regarding— 
‘‘(A) the programs and activities funded under the 
grant, contract, or agreement; and 
‘‘(B) outcomes related to such programs and activities. 
‘‘(b) IMPROVING DATA ON STATE AND NATIONAL PREVALENCE 
OF ALZHEIMER’S DISEASE AND RELATED DEMENTIAS.— 
‘‘(1) IN
GENERAL.—The Secretary shall, as appropriate, 
improve the analysis and timely reporting of data on the 
incidence and prevalence of Alzheimer’s disease and related 
dementias. Such data may include, as appropriate, information 
on cognitive decline, caregiving, and health disparities experi-
enced by individuals with cognitive decline and their caregivers. 
The Secretary may award grants, contracts, or cooperative 
agreements to eligible entities for activities under this para-
graph. 
‘‘(2) ELIGIBILITY.—To be eligible to receive a grant, contract, 
or cooperative agreement under this subsection, an entity shall 
be a public or nonprofit private entity, including institutions 
of higher education, State, local, and tribal health departments, 
and Indian tribes and tribal organizations, and submit to the 
Secretary an application at such time, in such manner, and 
containing such information as the Secretary may require. 
‘‘(3) DATA SOURCES.—The analysis, timely public reporting, 
and dissemination of data under this subsection may be carried 
out 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. 
‘‘(c) IMPROVED COORDINATION.—The Secretary shall ensure that 
activities and programs related to dementia under this section 
do not unnecessarily duplicate activities and programs of other 
agencies and offices within the Department of Health and Human 
Services.’’. 
Application. 
Analysis. 
Deadline. 
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132 STAT. 5365 
PUBLIC LAW 115–406—DEC. 31, 2018 
SEC. 3. SUPPORTING STATE PUBLIC HEALTH PROGRAMS RELATED 
TO ALZHEIMER’S DISEASE AND RELATED DEMENTIAS. 
Section 398 of the Public Health Service Act (42 U.S.C. 280c– 
3) is amended— 
(1) in the section heading, by striking ‘‘ESTABLISHMENT 
OF PROGRAM’’ and inserting ‘‘COOPERATIVE AGREEMENTS TO 
STATES AND PUBLIC HEALTH DEPARTMENTS FOR ALZHEIMER’S 
DISEASE AND RELATED DEMENTIAS’’; 
(2) by striking subsection (a) and inserting the following: 
‘‘(a) IN GENERAL.—The Secretary, in coordination with the 
Director of the Centers for Disease Control and Prevention and 
the heads of other agencies, as appropriate, shall award cooperative 
agreements to health departments of States, political subdivisions 
of States, and Indian tribes and tribal organizations, to address 
Alzheimer’s disease and related dementias, including by reducing 
cognitive decline, helping meet the needs of caregivers, and 
addressing unique aspects of Alzheimer’s disease and related 
dementias to support the development and implementation of evi-
dence-based interventions with respect to— 
‘‘(1) educating and informing the public, based on evidence- 
based public health research and data, about Alzheimer’s dis-
ease and related dementias; 
‘‘(2) supporting early detection and diagnosis; 
‘‘(3) reducing the risk of potentially avoidable hospitaliza-
tions for individuals with Alzheimer’s disease and related 
dementias; 
‘‘(4) reducing the risk of cognitive decline and cognitive 
impairment associated with Alzheimer’s disease and related 
dementias; 
‘‘(5) improving support to meet the needs of caregivers 
of individuals with Alzheimer’s disease and related dementias; 
‘‘(6) supporting care planning and management for individ-
uals with Alzheimer’s disease and related dementias. 
‘‘(7) supporting other relevant activities identified by the 
Secretary or the Director of the Centers for Disease Control 
and Prevention, as appropriate’’.; and 
(3) by striking subsection (b); 
(4) by redesignating subsection (c) as subsection (g); 
(5) by inserting after subsection (a), the following: 
‘‘(b) PREFERENCE.—In awarding cooperative agreements under 
this section, the Secretary shall give preference to applications 
that focus on addressing health disparities, including populations 
and geographic areas that have the highest prevalence of 
Alzheimer’s disease and related dementias. 
‘‘(c) ELIGIBILITY.—To be eligible to receive a cooperative agree-
ment under this section, an eligible entity (pursuant to subsection 
(a)) 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— 
‘‘(1) how the applicant proposes to develop or expand, pro-
grams to educate individuals through partnership engagement, 
workforce development, guidance and support for programmatic 
efforts, and evaluation with respect to Alzheimer’s disease and 
related dementias, and in the case of a cooperative agreement 
under this section, how the applicant proposes to support other 
relevant activities identified by the Secretary or Director of 
the Centers for Disease Control and Prevention, as appropriate. 
Application. 
Plan. 
Coordination. 
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132 STAT. 5366 
PUBLIC LAW 115–406—DEC. 31, 2018 
‘‘(2) the manner in which the applicant will coordinate 
with Federal, tribal, and State programs related to Alzheimer’s 
disease and related dementias, and appropriate State, tribal, 
and local agencies, as well as other relevant public and private 
organizations or agencies; and 
‘‘(3) the manner in which the applicant will evaluate the 
effectiveness of any program carried out under the cooperative 
agreement. 
‘‘(d) MATCHING REQUIREMENT.—Each health department that 
is awarded a cooperative agreement under subsection (a) shall 
provide, from non-Federal sources, an amount equal to 30 percent 
of the amount provided under such agreement (which may be pro-
vided in cash or in-kind) to carry out the activities supported 
by the cooperative agreement. 
‘‘(e) WAIVER AUTHORITY.—The Secretary may waive all or part 
of the matching requirement described in subsection (d) for any 
fiscal year for a health department of a State, political subdivision 
of a State, or Indian tribe and tribal organization (including those 
located in a rural area or frontier area), if the Secretary determines 
that applying such matching requirement would result in serious 
hardship or an inability to carry out the purposes of the cooperative 
agreement awarded to such health department of a State, political 
subdivision of a State, or Indian tribe and tribal organization.’’; 
(6) in subsection (f) (as so redesignated), by striking ‘‘grant’’ 
and inserting ‘‘cooperative agreement’’; and 
(7) by adding at the end the following: 
‘‘(f) NON-DUPLICATION OF EFFORT.—The Secretary shall ensure 
that activities under any cooperative agreement awarded under 
this subpart 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 with respect to 
Alzheimer’s disease and related dementias described in section 
398A; and 
‘‘(2) activities of public health departments with respect 
to Alzheimer’s disease and related dementias described in this 
section.’’. 
SEC. 4. ADDITIONAL PROVISIONS. 
Section 398B of the Public Health Service Act (42 U.S.C. 280c– 
5) is amended— 
(1) in subsection (a)— 
(A) by inserting ‘‘or cooperative agreement’’ after 
‘‘grant’’ each place that such appears; 
(B) by striking ‘‘section 398(a) to a State unless the 
State’’ and inserting ‘‘sections 398 or 398A to an entity 
unless the entity’’; and 
(C) by striking ‘‘10’’ and inserting ‘‘5’’; 
(2) by striking subsection (b); 
(3) by redesignating subsections (c) and (d) as subsections 
(b) and (c), respectively; 
(4) in subsection (b) (as so redesignated)— 
(A) in the matter preceding paragraph (1), by striking 
‘‘section 398(a) to a State unless the State’’ and inserting 
‘‘sections 398 or 398A to an entity unless the entity’’; 
(B) in paragraph (1), by striking ‘‘expenditures required 
in subsection (b);’’ and inserting ‘‘expenditures;’’; 
Determination. 
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132 STAT. 5367 
PUBLIC LAW 115–406—DEC. 31, 2018 
LEGISLATIVE HISTORY—S. 2076: 
CONGRESSIONAL RECORD, Vol. 164 (2018): 
Dec. 12, considered and passed Senate. 
Dec. 19, considered and passed House. 
(5) in subsection (c) (as so redesignated)— 
(A) in paragraph (1)— 
(i) by striking ‘‘each demonstration project for 
which a grant’’ and inserting ‘‘the activities for which 
an award’’; and 
(ii) by striking ‘‘section 398(a)’’ and inserting ‘‘sec-
tions 398 or 398A’’; and 
(B) in paragraph (2), by striking ‘‘6 months’’ and 
inserting ‘‘1 year’’; 
(6) by inserting after subsection (c) (as so redesignated), 
the following: 
‘‘(d) DEFINITION.—In this subpart, the terms ‘Indian tribe’ and 
‘tribal organization’ have the meanings given such terms in section 
4 of the Indian Health Care Improvement Act.’’; and 
(7) in subsection (e), by striking ‘‘$5,000,000 for each of 
the fiscal years 1988 through 1990’’ and all that follows through 
‘‘2002’’ and inserting ‘‘$20,000,000 for each of fiscal years 2020 
through 2024’’. 
Approved December 31, 2018. 
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