I
111th CONGRESS
2d Session
H. R. 5926
IN THE HOUSE OF REPRESENTATIVES
July 29, 2010
Mr. Markey of Massachusetts (for himself, Mr. Smith of New Jersey, Mr. Klein of Florida, and Mr. Garamendi) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned
A BILL
To amend title XVIII of the Social Security Act to provide for Medicare coverage of comprehensive Alzheimer’s disease and other dementia diagnosis and services in order to improve care and outcomes for Americans living with Alzheimer’s disease by increasing detection, diagnosis, care, and planning.
Short title
This Act may be cited as the
HOPE for Alzheimer’s: Health Outcomes,
Planning, and Education Act
.
Medicare coverage of comprehensive Alzheimer’s disease and other dementia diagnosis and services
In general
Section 1861 of the Social Security Act is amended—
in subsection (s)(2)—
by striking
and
at the end of subparagraph (EE);
by adding
and
at the end of subparagraph (FF); and
by adding at the end the following new subparagraph:
comprehensive Alzheimer’s disease and other dementia diagnosis and services (as defined in subsection (iii));
; and
by adding at the end the following new subsection:
Comprehensive Alzheimer’s disease and other dementia diagnosis and services
The term comprehensive Alzheimer’s disease and other dementia diagnosis and services means the services described in paragraph (2) furnished to an individual—
who does not already have a diagnosis of Alzheimer’s disease or other dementia; and
for whom there has been a determination by a physician or practitioner (as defined in section 1842(b)(18)(C)), in a medical setting such as a physician's office, a skilled nursing facility, a community health center, or another similar setting, that the individual—
may have a cognitive impairment or dementia; and
has a need for a diagnostic evaluation for Alzheimer’s disease or another dementia.
The services described in this paragraph are the following:
A diagnostic evaluation, including referral to a specialist if recommended, in accordance with guidelines specified by the Secretary.
If the individual is diagnosed with Alzheimer’s disease or another dementia under the evaluation under subparagraph (A), care planning services (with the individual or with one or more family caregivers of the individual without the presence of the individual), including assistance understanding the diagnosis as well as the medical and non-medical options for ongoing treatment, services, and supports, and information about how to obtain such treatments, services, and supports.
Medical record documentation, with respect to an individual, of the diagnostic evaluation under subparagraph (A) and any care planning services under subparagraph (B).
The Secretary shall establish standards to carry out this subsection in consultation with Alzheimer’s disease and other dementia stakeholders, including patients and their advocates, and medical experts in the areas of detection, diagnostics, and care planning.
.
Payment
Section 1833(a)(1) of the Social Security
Act (42 U.S.C. 1395l(a)(1)) is amended by striking and
before
(X)
and inserting before the semicolon at the end the following:
, and (Y) with respect to comprehensive Alzheimer’s disease and other
dementia diagnosis and services (as defined in section 1861(iii)), the amount
paid shall be an amount equal to 80 percent of the amount determined under a
fee schedule established by the Secretary
.
Effective date
The amendments made by this section shall apply to services furnished on or after January 1, 2011.
Federal Coordinated Health Care Office study and report
Study
The Federal Coordinated Health Care Office (as established under section 2602 of the Patient Protection and Affordable Care Act (42 U.S.C. 1315b)) shall conduct a study to identify—
barriers to the detection of Alzheimer’s disease and other dementias for dual eligible individuals (as defined in subsection (f) of such section 2602);
barriers to the furnishing of comprehensive Alzheimer's disease and other dementia diagnosis and services (as defined in section 1866(iii) of the Social Security Act, as added by section 2) to such individuals; and
ways to eliminate the barriers described in paragraphs (1) and (2).
Report
Not later than 2 years after the date of the enactment of this Act, the Federal Coordinated Health Care Office shall submit to Congress a report on the study conducted under subsection (a) together with recommendations for such legislation and administrative actions as the Office determines appropriate.