,,ii #aadth ,,congress #ast ,session ,s4 #heg ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #be1 #bjae ,ms4 ,stabenow 7for herself1 ,ms4 ,collins1 ,mr4 ,markey1 and ,mrs4 ,capito7 introduced the following bill2 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 coverage under the ,medicare program of an initial comprehensive care plan for ,medicare beneficiaries newly diagnosed with ,alzheimer's disease and related dementias1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,health ,outcomes1 ,planning1 and ,education 7,,hope7 for ,alzheimer's ,act of #bjae4 #b4 ,findings and purpose 7a7 ,findings ,congress makes the following findings3 7#a7 ,as many as half of the estimated #e1ajj1jjj ,american seniors with ,alzheimer's disease and other dementias have never received a diagnosis4 7#b7 ,an early and documented diagnosis and access to care planning services leads to better outcomes for individuals with ,alzheimer's disease and other dementias and their caregivers4 7#c7 ,building upon the existing ,medicare benefit of a diagnostic evaluation to add comprehensive care planning services would help ensure that beneficiaries and their families receive critical information about the disease and available care options1 which leads to better outcomes4 7#d7 ,an accurate1 timely1 and documented diagnosis allows for better management of other known chronic conditions and more efficient utilization of medical resources1 including reducing complications and the number of costly emergency room visits and hospitalizations4 7#e7 ,a formal and documented diagnosis and care planning services allow individuals and their caregivers to have access to available medical and non-medical treatments1 build a care team1 participate in support services1 and enroll in clinical trials4 7b7 ,purpose ,the purpose of this ,act is to provide better care and outcomes for ,medicare beneficiaries living with ,alzheimer's disease and related dementias by building upon existing ,medicare coverage of a diagnostic evaluation for ,alzheimer's disease and related dementias to add coverage of initial comprehensive care planning services for ,medicare beneficiaries who are first diagnosed with ,alzheimer's disease or related dementias on or after the date of the enactment of this ,act and whose medical records contain the documented diagnosis of the disease4 #c4 ,medicare coverage of comprehensive alzheimer's disease care planning services 7a7 ,in general ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is amended-- 7#a7 in subsection 7s77#b7-- 7,a7 by striking and at the end of subparagraph 7,,ee72 7,b7 by adding and at the end of subparagraph 7,,ff72 and 7,c7 by adding at the end the following new subparagraph3 7,,gg7 comprehensive ,alzheimer's disease care planning services 7as defined in subsection 7iii772 2 and 7#b7 by adding at the end the following new subsection3 7iii7 ,comprehensive ,alzheimer's disease care planning services 7#a7 7,a7 ,subject to subparagraph 7,b71 the term comprehensive ,alzheimer's disease care planning services means the services described in paragraph 7#b7 furnished by a physician or non-physician practitioner to any or all of the following3 7i7 ,an eligible individual4 7ii7 ,the personal representative of such eligible individual1 with or without the presence of the eligible individual4 7iii7 ,one or more family caregivers of such eligible individual1 with or without the presence of the eligible individual4 7,b7 ,the ,secretary shall establish guidelines for the furnishing of ,comprehensive ,alzheimer's disease care planning services to individuals described in clauses 7i71 7ii71 and 7iii7 of subparagraph 7,a74 7#b7 7,a7 ,subject to the succeeding provisions of this paragraph1 the services described in this paragraph are the development and furnishing of an initial comprehensive care plan to an eligible individual that provides such information and services as the ,secretary may specify 7in consultation with stakeholders as provided in paragraph 7#e771 which-- 7i7 includes-- 7,i7 assistance understanding the diagnosis2 7,,ii7 assistance understanding medical and non-medical options for ongoing treatment1 services1 and supports2 and 7,,iii7 information about how to obtain the treatments1 services1 and supports described in subclause 7,,ii72 and 7ii7 takes into account the eligible individual's other co-morbid chronic conditions4 7,b7 ,the services described in this paragraph shall also include comprehensive medical record documentation1 with respect to the eligible individual of the care planning services under subparagraph 7,a71 by the physician or non-physician practitioner furnishing the services4 7#c7 ,subject to paragraph 7#e71 the ,secretary shall periodically update requirements under this subsection to reflect advances in science and technology4 7#d7 7,a7 ,comprehensive ,alzheimer's disease care planning services may only be furnished once with respect to each eligible individual4 7,b7 ,nothing in this subsection shall be construed as prohibiting an update of any initial comprehensive care plan furnished under this subsection to an eligible individual under physicians' services that are covered under other provisions of this title1 such as care planning under personalized prevention plan services 7as defined in subsection 7hhh77#a774 7#e7 ,the ,secretary shall consult with stakeholders1 such as physicians1 non-physician practitioners1 and organizations that represent individuals 7including individuals under this title7 with ,alzheimer's disease1 with respect to each of the following3 7,a7 ,the scope of1 and requirements for1 services described in paragraph 7#b74 7,b7 ,the periodic updates of requirements under paragraph 7#c74 7#f7 ,in this subsection3 7,a7 ,the term ,alzheimers disease' means ,alzheimer's disease and related dementias4 7,b7 ,the term eligible individual means an individual who-- 7i7 has a documented diagnosis of ,alzheimer's disease in the medical record2 and 7ii7 was first diagnosed as having ,alzheimer's disease on or after the date of the enactment of this subsection4 7,c7 ,the term non-physician practitioner means a practitioner described in clause 7i71 7iv71 or 7v7 of section #ahdb7;b77#ah77;,c74 7,d7 ,the term personal representative means1 with respect to an individual1 a person legally authorized to make health care decisions on such individual's behalf4 7,e7 ,the term physician has the meaning given that term in subsection 7r77#a74 4 7b7 ,payment 7#a7 ,in general ,section #ahcc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a77 is amended-- 7,a7 by striking and before 7,z72 and 7,b7 by inserting before the semicolon at the end the following3 1 and 7,,aa7 with respect to comprehensive ,alzheimer's disease care planning services 7as defined in section #ahfa7;iii77#b771 the amount paid shall be an amount equal to #hj percent of the lesser of the actual charge for the services or the amount determined under the payment basis determined under section #ahdh44 7#b7 ,payment under physician fee schedule ,section #ahdh7;j77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;j77#c77 is amended by inserting 7#b77;,,gg71 after 7#b77;,,ff7 7including administration of the health risk assessment714 7#c7 ,frequency limitation ,section #ahfb7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77#a77 is amended-- 7,a7 in subparagraph 7,o71 by striking and at the end2 7,b7 in subparagraph 7,p71 by striking the semicolon at the end and inserting 1 and2 and 7,c7 by adding at the end the following new subparagraph3 7,q7 in the case of comprehensive ,alzheimer's disease care planning services 7as defined in section #ahfa7;iii77#a771 which are performed more frequently than is covered under such section2 4 7c7 ,provider outreach and reporting on care planning services 7#a7 ,outreach ,the ,secretary of ,health and ,human ,services 7in this subsection referred to as the ,secretary7 shall conduct outreach to physicians and appropriate non-physician practitioners participating under the ,medicare program with respect to the amendments made by subsections 7a7 and 7b74 ,such outreach shall include a comprehensive1 one-time education initiative to inform such physicians and practitioners of the addition of comprehensive ,alzheimer's disease care planning services as a covered benefit under the ,medicare program1 including materials on appropriate diagnostic evaluations and explanations of the requirements for eligibility for such services4 7#b7 ,reports to ,congress 7,a7 ,provider outreach ,not later than one year after the effective date of the amendments made by subsections 7a7 and 7b7 7as described in subsection 7d771 the ,secretary shall submit to the ,committee on ,ways and ,means and the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,finance of the ,senate a report on the outreach conducted under paragraph 7#a74 ,such report shall include a description of the methods used for such outreach4 7,b7 ,utilization rates ,not later than #ah months after the effective date of the amendments made by subsections 7a7 and 7b7 7as described in subsection 7d77 and annually thereafter for the succeeding five years1 the ,secretary shall submit to the ,committee on ,ways and ,means and the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,finance of the ,senate a report on the number of ,medicare beneficiaries who1 during the preceding year1 were furnished comprehensive ,alzheimer's disease care planning services for which payment was made under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 ,each such report shall include information on any barriers ,medicare beneficiaries face to access such services and the ,secretary's recommendations to eliminate any such barriers4 7,c7 ,copy of each report ,on the same day that a report is submitted under subparagraph 7,a7 or 7,b7 of paragraph 7#b71 the ,secretary shall transmit a copy of such report to the ,advisory ,council on ,alzheimer's ,research1 ,care1 and ,services 7established under section #b7;e7 of the ,national ,alzheimer's ,project ,act 7,public ,law #aaa-cge74 7d7 ,effective date ,the amendments made by subsections 7a7 and 7b7 shall apply to services furnished on or after ,january #a of the year following the year which includes the date of the enactment of this ,act4