,,ii  #aaeth ,,congress  #ast ,session  
,s4 #bjgf  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,november #f1  
#bjag,ms4 ,collins 7for herself1 ,ms4   
,cortez ,masto1 ,mrs4 ,capito1 and ,mr4 
,kaine7 introduced the following bill2  
which was read twice and referred to the
 ,committee on ,health1 ,education1     
,labor1 and ,pensions  ,a ,,bill  ,to   
amend the ,public ,health ,service ,act 
to authorize the expansion of activities
 related to ,alzheimer's disease1       
cognitive decline1 and brain health     
under the ,alzheimer's ,disease and     
,healthy ,aging ,program1 and for other 
purposes4  #a4 ,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 ,act4  
#b4 ,findings ,congress finds as        
follows3  7#a7 ,according to former     
,surgeon ,general and ,director of the  
,centers for ,disease ,control and      
,prevention1 ,dr4 ,david ,satcher1      

,alzheimer's is the most                
under-recognized threat to public health
 in the #bast century44  7#b7 ,deaths   
from ,alzheimer's disease increased #ee 
percent between #aiii and #bjad in the  
,united ,states1 according to data from 
the ,centers for ,disease ,control and  
,prevention4  7#c7 ,more than #e1jjj1jjj
 people in the ,united ,states are      
living with ,alzheimer's disease and1   
without significant efforts to change   
the current trajectory1 as many as      
#af1jjj1jjj people in the ,united       
,states will have ,alzheimer's disease  
by #bjej4 ,this explosive growth will   
cause costs associated with ,alzheimer's
 disease to increase from an estimated  
#bei1jjj1jjj1jjj in #bjag to more than  
#a1ajj1jjj1jjj1jjj in #bjej 7in #bjag   
dollars74  7#d7 ,among individuals      
living with ,alzheimer's disease and    
other dementias1 evidence indicates as  
many as #ej percent have not been       
diagnosed4 ,among individuals diagnosed 
with ,alzheimer's disease1 only #cc     

percent are aware of the diagnosis4     
,early detection and diagnosis of       
,alzheimer's disease and other dementias
 allow people to access available       
treatments1 build a care team1          
participate in support services1 and    
enroll in clinical trials4 ,early       
detection can help physicians better    
manage a patient's comorbid conditions  
and avoid prescribing medications that  
may worsen cognition or function4  7#e7 
,among individuals living with          
,alzheimer's disease and other          
dementias1 #be4c percent experience a   
preventable hospitalization1 and such   
preventable hospitalizations cost the   
,medicare program nearly #b1fjj1jjj1jjj 
in #bjac4  7#f7 ,african ,americans are 
about #b times more likely than ,white  
,americans to have ,alzheimer's disease 
and other dementias4 ,hispanics are     
about one and one-half times more likely
 than ,white ,americans to have         
,alzheimer's disease and other          
dementias4  7#g7 ,in #bjaf1 #ae1ijj1jjj 

family members and friends provided     
#ah1bjj1jjj1jjj hours of unpaid care to 
individuals with ,alzheimer's disease   
and other dementias1 at an economic     
value of over #bcj1jjj1jjj1jjj4 ,the    
physical and emotional impact of        
caregiving of individuals with          
,alzheimer's disease and other dementia 
resulted in an estimated #aj1ijj1jjj1jjj
 in increased caregiver health costs in 
#bjaf4  7#h7 ,strategy #d4;,b of the    
,national ,plan to ,address ,alzheimer's
 ,disease3 #bjag ,update of the ,office 
of the ,assistant ,secretary for        
,planning and ,evaluation of the        
,department of ,health and ,human       
,services is to work with ,state1       
,tribal1 and local governments to       
improve coordination and identify model 
initiatives to advance ,alzheimer's     
disease awareness and readiness across  
the ,government44  #c4 ,promotion of    
public health knowledge and awareness of
 ,alzheimer's disease1 cognitive        
decline1 and brain health under the     

,alzheimer's ,disease and ,healthy      
,aging ,program ,part ,p of title ,,iii 
of the ,public ,health ,service ,act    
7#db ,u4,s4,c4 #bhj;g et seq47 is       
amended by adding at the end the        
following3  #cii,v-#g4 ,promotion of    
public health knowledge and awareness of
 ,alzheimer's disease1 cognitive        
decline1 and brain health under the     
,alzheimer's ,disease and ,healthy      
,aging ,program  7a7 ,definitions ,in   
the section3 7#a7 ,alzheimer's disease  
,the term ,alzheimer's disease means    
,alzheimer's disease and related        
dementias4  7#b7 ,indian tribe2 tribal  
organization ,the terms ,indian tribe   
and tribal organization have the        
meanings given such terms in section #d 
of the ,indian ,health ,care            
,improvement ,act4  7b7 ,expansion of   
activities under the ,alzheimer's       
,disease and ,healthy ,aging ,program   
,in addition to activities conducted by 
the ,secretary under the ,alzheimer's   
,disease and ,healthy ,aging ,program of

 the ,centers for ,disease ,control and 
,prevention1 the ,secretary1 acting     
through the ,director of the ,centers   
for ,disease ,control and ,prevention1  
subject to appropriations under         
subsection 7g71 shall award cooperative 
agreements under subsections 7c71 7d71  
and 7e74  7c7 ,centers of excellence in 
public health practice  7#a7 ,in general
 ,the ,secretary shall award cooperative
 agreements to eligible entities for the
 establishment or support of national or
 regional centers of excellence in      
public health practice in ,alzheimer's  
disease to--  7,a7 advance the education
 of public health officials of ,states1 
of political subdivisions of ,states1   
and of ,indian tribes or tribal         
organizations1 health care              
professionals1 and the public on        
,alzheimer's disease1 cognitive decline1
 brain health1 and associated health    
disparities2  7,b7 advance the efforts  
of public health officials referred to  
in subparagraph 7,a7 in applying        

evidence-based systems change1          
communications1 and programmatic        
interventions for populations with      
cognitive impairment1 including         
,alzheimer's disease1 and caregivers for
 such populations2 and  7,c7 expand     
public-private partnerships engaged in  
activities related to cognitive         
impairment and associated health        
disparities with demonstrated success or
 innovative programs 7as determined by  
the ,secretary74  7#b7 ,requirements ,to
 be eligible to receive a cooperative   
agreement under this subsection1 an     
entity shall submit to the ,secretary an
 application containing such agreements 
and information as the ,secretary may   
require1 including an agreement that the
 center to be established or supported  
under the cooperative agreement will    
operate in accordance with the          
following3  7,a7 ,the center will       
examine1 evaluate1 increase1 and promote
 evidence-based and effective           
,alzheimer's disease and                

caregiving-related interventions for    
health and social services              
professionals1 underserved populations1 
families1 and the public1 after         
consultation with relevant ,state and   
local public health officials1          
private-sector ,alzheimer's disease     
researchers1 and advocates for          
individuals with ,alzheimer's disease4  
7,b7 ,the center will prioritize its    
activities on the following3 7i7        
,expanding efforts to educate ,state1   
local1 and tribal officials and public  
health professionals in applying        
established data and evidence-based best
 practices to address ,alzheimer's      
disease4  7ii7 ,supporting public health
 officials of ,states1 of political     
subdivisions of ,states1 and of ,indian 
tribes or tribal organizations in       
implementing the most current version of
 the ,healthy ,brain ,initiative3       
,public ,health ,road ,map of the       
,centers for ,disease ,control and      
,prevention4  7iii7 ,supporting early   

detection and diagnosis of ,alzheimer's 
disease4  7iv7 ,reducing the risk of    
potentially avoidable hospitalizations  
of individuals with ,alzheimer's        
disease4  7v7 ,reducing the risk of     
cognitive decline and cognitive         
impairment1 including ,alzheimer's      
disease4  7vi7 ,enhancing support to    
meet the needs of caregivers of         
individuals with ,alzheimer's disease4  
7vii7 ,reducing health disparities      
related to the care and support of      
individuals with cognitive decline and  
,alzheimer's disease4  7viii7           
,supporting care planning and management
 for individuals with ,alzheimer's      
disease4  7#c7 ,considerations ,in      
awarding cooperative agreements under   
this subsection1 the ,secretary shall   
consider1 among other factors1 whether  
the entity--  7,a7 has access to rural  
areas or other underserved populations2 
7,b7 is located in an area where the    
aggregate success rate for applications 
for ,national ,institutes of ,health    

funding has been historically low2  7,c7
 is able to build on an existing        
infrastructure of service and public    
health research2  7,d7 has experience   
with providing care1 caregiver support1 
and research related to ,alzheimer's    
disease2 and  7,e7 is integrated into   
existing local government and public    
health infrastructures4  7#d7           
,distribution of awards ,in awarding    
cooperative agreements under this       
subsection1 the ,secretary1 to the      
extent practicable1 shall ensure        
equitable distribution of awards based  
on geographic area1 including           
consideration of rural areas1 and the   
burden of the disease on                
sub-populations4  7d7 ,cooperative      
agreements to public health departments 
7#a7 ,in general ,the ,secretary shall  
award cooperative agreements to health  
departments of ,states1 of political    
subdivisions of ,states1 and of ,indian 
tribes and tribal organizations to      
promote cognitive functioning1 address  

cognitive impairment for individuals    
living in such communities1 help meet   
the needs of caregivers1 and address    
unique aspects of ,alzheimer's disease1 
as follows3  7,a7 ,the ,secretary shall 
award core capacity cooperative         
agreements to such health departments to
 support the development and            
implementation of systems change1       
communications1 and programmatic        
interventions with respect to           
,alzheimer's disease1 including         
activities involving--  7i7 educating   
and informing the public based on       
established public health research and  
data2  7ii7 supporting early detection  
and diagnosis2  7iii7 reducing the risk 
of potentially avoidable                
hospitalizations2  7iv7 reducing the    
risk of cognitive decline and cognitive 
impairment2  7v7 enhancing support to   
meet the needs of caregivers2  7vi7     
supporting care planning and management2
 or  7vii7 supporting the actions set   
forth in the most current version of the

 ,healthy ,brain ,initiative3 ,public   
,health ,road ,map of the ,centers for  
,disease ,control and ,prevention4  7,b7
 ,the ,secretary shall award not less   
than #e enhanced activity cooperative   
agreements to such health departments to
 carry out activities related to        
,alzheimer's disease1 including through 
public-private partnerships with        
organizations or other agencies1 such as
 large employers1 public housing        
agencies1 large health care systems1 and
 parks and recreation departments1 that 
include--  7i7 expanding implementation 
of programs described in paragraph      
7#b77;,a7 to reach larger segments of   
the population2 and  7ii7 implementing  
the reports described in subparagraph   
7,a77vii74  7#b7 ,other considerations  
7,a7 ,preference ,in awarding           
cooperative agreements under paragraph  
7#a71 the ,secretary shall give         
preference to applications that focus on
 addressing health disparities1         
including populations and geographic    

areas that are most in need of          
intervention4  7,b7 ,clarification on   
enhanced activity cooperative agreements
 ,if the ,secretary is unable to        
identify #e eligible health departments 
to receive a cooperative agreement under
 paragraph 7#a77;,b71 the ,secretary    
shall allocate any amounts reserved for 
such agreements to additional           
cooperative agreements under paragraph  
7#a77;,a74  7#c7 ,eligibility ,to be    
eligible to receive a cooperative       
agreement under paragraph 7#a71 a       
,state1 political subdivision of a      
,state1 ,indian tribe1 or tribal        
organization shall prepare and submit to
 the ,secretary an application at such  
time1 in such manner1 and containing    
such information as the ,secretary may  
require1 including a plan that          
describes--  7,a7 how the applicant     
proposes to develop or expand1 programs 
to educate individuals through          
partnership engagement1 workforce       
development1 guidance and support for   

programmatic efforts1 strategic         
communication1 and evaluation with      
respect to ,alzheimer's disease1 and in 
the case of a cooperative agreement     
under paragraph 7#a77;,b71 how the      
applicant proposes to implement the most
 current version of the ,healthy ,brain 
,initiative3 ,public ,health ,road ,map 
of the ,centers for ,disease ,control   
and ,prevention2  7,b7 the manner in    
which the applicant will coordinate with
 appropriate ,state and local           
authorities as well as1 in the case of a
 cooperative agreement under paragraph  
7#a77;,b71 relevant public and private  
organizations or agencies2 and  7,c7 the
 manner in which the applicant will     
evaluate the effectiveness of any       
program carried out under the           
cooperative agreement4  7#d7 ,use of    
funds ,a health department awarded a    
cooperative agreement under paragraph   
7#a7 shall use amounts received under   
such cooperative agreement to--  7,a7   
develop1 implement1 disseminate1        

evaluate1 and if applicable1 expand     
programs to educate individuals on      
matters related to ,alzheimer's disease 
described in paragraph 7#a77;,a72 and   
7,b7 in the case of a cooperative       
agreement under paragraph 7#a77;,b71    
implement the most current version of   
the ,healthy ,brain ,initiative3 ,public
 ,health ,road ,map of the ,centers for 
,disease ,control and ,prevention and   
evaluate its implementation4  7#e7      
,matching requirement  7,a7 ,in general 
,except as may be provided in           
subparagraph 7,b71 each health          
department that is awarded a cooperative
 agreement under paragraph 7#a7 shall   
provide1 from non-,federal sources1 an  
amount equal to #ae percent of the      
amount provided under such agreement    
7which may be provided in cash or       
in-kind7 to carry out the activities    
supported by the cooperative agreement4 
7,b7 ,waiver authority ,the ,secretary  
may waive all or part of the matching   
requirement described in subparagraph   

7,a7 for any fiscal year for--  7i7 a   
health department1 if the ,secretary    
determines that applying such matching  
requirement to the health department    
would result in serious hardship or an  
inability to carry out the purposes of  
the cooperative agreement awarded to    
such health department2 or  7ii7 a rural
 or frontier region4  7e7 ,cooperative  
agreements for analysis and reporting of
 data regarding cognitive decline and   
caregiving  7#a7 ,in general ,the       
,secretary may award cooperative        
agreements to eligible entities for the 
following activities3  7,a7 ,the        
analysis and timely public reporting of 
data on the ,state and national levels  
regarding cognitive decline1 including  
,alzheimer's disease1 caregiving1 and   
health disparities experienced by       
individuals with cognitive decline and  
their caregivers4  7,b7 ,the monitoring 
of objectives on dementia1 including    
,alzheimer's disease1 and caregiving in 
the program of the ,secretary regarding 

health-status goals for #bjbj 7commonly 
referred to as the ,healthy ,people     
#bjbj report71 and the development and  
monitoring of such objectives in future 
,healthy ,people reports of the         
,department of ,health and ,human       
,services4  7#b7 ,eligibility ,to be    
eligible to receive a cooperative       
agreement under this subsection1 an     
entity shall be a public or nonprofit   
private entity1 including institutions  
of higher education1 and submit to the  
,secretary an application at such time1 
in such manner1 and containing such     
information as the ,secretary may       
require4  7#c7 ,surveillance ,the       
analysis1 timely public reporting1 and  
dissemination of data regarding         
cognitive decline1 cognitive impairment1
 caregiving1 and health disparities on  
the ,state and national levels under a  
cooperative agreement under this        
subsection may be carried out by        
eligible entities using data sources    
such as the following3  7,a7 ,the       

,behavioral ,risk ,factor ,surveillance 
,system4  7,b7 ,the ,national ,health   
and ,nutrition ,examination ,survey4    
7,c7 ,the ,national ,health ,interview  
,survey4  7f7 ,data collection ,the     
,secretary shall collect data on        
cognitive decline1 cognitive impairment1
 caregiving1 and health disparities on  
the ,state and national levels1 using   
the surveillance systems described in   
subparagraphs 7,a7 through 7,c7 of      
subsection 7e77#c74  7g7 ,nonduplication
 of effort ,the ,secretary shall ensure 
that activities under any cooperative   
agreement awarded under this section do 
not unnecessarily duplicate efforts of  
other agencies and offices within the   
,department of ,health and ,human       
,services related to--  7#a7 activities 
of centers of excellence in public      
health practice with respect to         
,alzheimer's disease described in       
subsection 7c72  7#b7 activities of     
public health departments with respect  
to ,alzheimer's disease described in    

subsection 7d72 or  7#c7 the analysis   
and public reporting of surveillance    
data on cognitive decline1 caregiving1  
and health disparities of individuals   
with ,alzheimer's disease under         
subsection 7e74  7h7 ,authorization of  
appropriations ,for each of fiscal years
 #bjah through #bjbe1 there are         
authorized to be appropriated           
#ab1jjj1jjj for purposes of carrying out
 subsection 7c71 #bj1jjj1jjj for        
purposes of carrying out subsection 7d71
 and #e1jjj1jjj for purposes of carrying
 out subsections 7e7 and 7f74 ,funds    
appropriated under this subsection shall
 remain available until expended4  4