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S 738

112th CONGRESS
1st Session

S. 738

To amend title XVIII of the Social Security Act to provide for Medicare coverage of comprehensive Alzheimer's disease and related dementia diagnosis and services in order to improve care and outcomes for Americans living with Alzheimer's disease and related dementias by improving detection, diagnosis, and care planning.

IN THE SENATE OF THE UNITED STATES

April 6 (legislative day, April 5), 2011

Ms. STABENOW (for herself and Ms. COLLINS) 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 Medicare coverage of comprehensive Alzheimer's disease and related dementia diagnosis and services in order to improve care and outcomes for Americans living with Alzheimer's disease and related dementias by improving detection, diagnosis, and care planning.

    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 `Health Outcomes, Planning, and Education for Alzheimer's Act'.

SEC. 2. MEDICARE COVERAGE OF COMPREHENSIVE ALZHEIMER'S DISEASE DIAGNOSIS AND SERVICES.

    (a) In General- Section 1861 of the Social Security Act is amended--

      (1) in subsection (s)(2)--

        (A) by striking `and' at the end of subparagraph (EE);

        (B) by adding `and' at the end of subparagraph (FF); and

        (C) by adding at the end the following new subparagraph:

      `(GG) comprehensive Alzheimer's disease diagnosis and services (as defined in subsection (iii));'; and

      (2) by adding at the end the following new subsection:

`Comprehensive Alzheimer's Disease Diagnosis and Services

    `(iii)(1) The term `comprehensive Alzheimer's disease diagnosis and services' means the services described in paragraph (2) furnished to an individual--

      `(A) who does not already have a diagnosis of Alzheimer's disease; and

      `(B) for whom a physician or a practitioner described in clause (i), (iv), or (v) of section 1842(b)(18)(C), in a medical setting such as a physician's office, a hospital, a skilled nursing facility, a community health center, or another similar medical setting--

        `(i) has detected the individual may have a cognitive impairment or dementia; and

        `(ii) pursuant to such detection, has determined a diagnostic evaluation for Alzheimer's disease is needed.

    `(2) The services described in this paragraph are the following:

      `(A) A diagnostic evaluation, including referral to a specialist if recommended.

      `(B) If the individual is diagnosed with Alzheimer's disease under the diagnostic 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.

      `(C) Medical record documentation, with respect to an individual, of the diagnostic evaluation under subparagraph (A), the diagnosis, and any care planning services under subparagraph (B).

    `(3) In this subsection, the term `Alzheimer's disease' means Alzheimer's disease and related dementias.'.

    (b) Payment- Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended by striking `and' before `(Z)' and inserting before the semicolon at the end the following: `, and (AA) with respect to comprehensive Alzheimer's disease 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 designated by the Secretary'.

    (c) Effective Date- The amendments made by this section shall apply to services furnished on or after January 1 of the year following the year which includes the date of the enactment of this Act.

END