,,ii ,calendar ,no4 #fid #aaeth ,,congress #b;d ,session ,s4 #bjgf ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,november #f1 #bjag,ms4 ,collins 7for herself1 ,ms4 ,cortez ,masto1 ,mrs4 ,capito1 ,mr4 ,kaine1 ,mr4 ,coons1 ,mr4 ,wicker1 ,mr4 ,markey1 ,ms4 ,stabenow1 ,mr4 ,king1 ,ms4 ,warren1 ,mr4 ,crapo1 ,mr4 ,young1 ,mr4 ,risch1 ,mr4 ,van ,hollen1 ,mr4 ,moran1 ,mr4 ,blumenthal1 ,mr4 ,inhofe1 ,mr4 ,boozman1 ,mr4 ,rounds1 ,mr4 ,sanders1 ,mr4 ,barrasso1 ,mrs4 ,shaheen1 ,mr4 ,gardner1 ,ms4 ,heitkamp1 ,mr4 ,casey1 ,mr4 ,kennedy1 ,ms4 ,klobuchar1 ,mr4 ,nelson1 ,mr4 ,murphy1 ,mr4 ,cassidy1 ,mr4 ,tillis1 ,ms4 ,hassan1 ,ms4 ,smith1 ,mrs4 ,fischer1 ,ms4 ,murkowski1 ,ms4 ,hirono1 ,mr4 ,donnelly1 ,mrs4 ,gillibrand1 ,mr4 ,bennet1 ,mr4 ,jones1 ,ms4 ,baldwin1 ,mr4 ,merkley1 ,mr4 ,whitehouse1 ,mr4 ,peters1 ,mrs4 ,hyde-,smith1 ,mr4 ,tester1 ,mr4 ,menendez1 ,mrs4 ,feinstein1 ,mr4 ,sullivan1 ,mr4 ,wyden1 ,mr4 ,roberts1 ,mr4 ,heinrich1 ,mr4 ,reed1 ,mr4 ,booker1 ,mr4 ,brown1 and ,ms4 ,harris7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,november #bi1 #bjah,reported by ,mr4 ,alexander1 with an amendment,strike out all after the enacting clause and insert the part printed in italic ,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 #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 ,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 ,k of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;c et seq47 is amended-- 7#a7 in the part heading1 by adding ,,and ,,public ,,health ,,programs ,,for ,,dementia at the end2 and 7#b7 in subpart ,,ii-- 7,a7 by striking the subpart heading and inserting the following3 ,,ii ,programs ,with ,respect to ,alzheimer's ,disease and ,related ,dementias 2 and 7,b7 by striking section #cih;,a 7#db ,u4,s4,c4 #bhj;c-#d7 and inserting the following3 #cih;,a4 ,promotion of public health knowledge and awareness of ,alzheimer's disease and related dementias 7a7 ,alzheimer's ,disease and ,related ,dementias ,public ,health ,centers of ,excellence 7#a7 ,in general ,the ,secretary1 in coordination with the ,director of the ,centers for ,disease ,control and ,prevention and the heads of other agencies as appropriate1 shall award grants1 contracts1 or cooperative agreements to eligible entities1 such as institutions of higher education1 ,state1 tribal1 and local health departments1 ,indian tribes1 tribal organizations1 associations1 or other appropriate entities for the establishment or support of regional centers to address ,alzheimer's disease and related dementias by-- 7,a7 advancing the awareness of public health officials1 health care professionals1 and the public1 on the most current information and research related to ,alzheimer's disease and related dementias1 including cognitive decline1 brain health1 and associated health disparities2 7,b7 identifying and translating promising research findings1 such as findings from research and activities conducted or supported by the ,national ,institutes of ,health1 including ,alzheimer's ,disease ,research ,centers authorized by section #dde1 into evidence-based programmatic interventions for populations with ,alzheimer's disease and related dementias and caregivers for such populations2 and 7,c7 expanding activities1 including through public-private partnerships related to ,alzheimer's disease and related dementias and associated health disparities4 7#b7 ,requirements ,to be eligible to receive a grant1 contract1 or 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 a description of how the entity will-- 7,a7 coordinate1 as applicable1 with existing ,federal1 ,state1 and tribal programs related to ,alzheimer's disease and related dementias2 7,b7 examine1 evaluate1 and promote evidence-based interventions for individuals with ,alzheimer's disease and related dementias1 including underserved populations with such conditions1 and those who provide care for such individuals2 and 7,c7 prioritize activities relating to-- 7i7 expanding efforts1 as appropriate1 to implement evidence-based practices to address ,alzheimer's disease and related dementias1 including through the training of ,state1 local1 and tribal public health officials and other health professionals on such practices2 7ii7 supporting early detection and diagnosis of ,alzheimer's disease and related dementias2 7iii7 reducing the risk of potentially avoidable hospitalizations of individuals with ,alzheimer's disease and related dementias2 7iv7 reducing the risk of cognitive decline and cognitive impairment associated with ,alzheimer's disease and related dementias2 7v7 enhancing support to meet the needs of caregivers of individuals with ,alzheimer's disease and related dementias2 7vi7 reducing health disparities related to the care and support of individuals with ,alzheimer's disease and related dementias2 7vii7 supporting care planning and management for individuals with ,alzheimer's disease and related dementias2 and 7viii7 supporting other relevant activities identified by the ,secretary or the ,director of the ,centers for ,disease ,control and ,prevention1 as appropriate4 7#c7 ,considerations ,in awarding grants1 contracts1 and cooperative agreements under this subsection1 the ,secretary shall consider1 among other factors1 whether the entity-- 7,a7 provides services to rural areas or other underserved populations2 7,b7 is able to build on an existing infrastructure of services and public health research2 and 7,c7 has experience with providing care or caregiver support1 or has experience conducting research related to ,alzheimer's disease and related dementias4 7#d7 ,distribution of awards ,in awarding grants1 contracts1 or 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 within sub-populations4 7#e7 ,data reporting and program oversight ,with respect to a grant1 contract1 or cooperative agreement awarded under this subsection1 not later than #ij days after the end of the first year of the period of assistance1 and annually thereafter for the duration of the grant1 contract1 or agreement 7including the duration of any renewal period as provided for under paragraph 7#e771 the entity shall submit data1 as appropriate1 to the ,secretary regarding-- 7,a7 the programs and activities funded under the grant1 contract1 or agreement2 and 7,b7 outcomes related to such programs and activities4 7b7 ,improving data on ,state and national prevalence of ,alzheimer's disease and related dementias 7#a7 ,in general ,the ,secretary shall1 as appropriate1 improve the analysis and timely reporting of data on the incidence and prevalence of ,alzheimer's disease and related dementias4 ,such data may include1 as appropriate1 information on cognitive decline1 caregiving1 and health disparities experienced by individuals with cognitive decline and their caregivers4 ,the ,secretary may award grants1 contracts1 or cooperative agreements to eligible entities for activities under this paragraph4 7#b7 ,eligibility ,to be eligible to receive a grant1 contract1 or cooperative agreement under this subsection1 an entity shall be a public or nonprofit private entity1 including institutions of higher education1 ,state1 local1 and tribal health departments1 and ,indian tribes and tribal organizations1 and submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7#c7 ,data sources ,the analysis1 timely public reporting1 and dissemination of data under this subsection may be carried out 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 7c7 ,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 ,services4 4 #c4 ,supporting state public health programs related to alzheimer's disease and related dementias ,section #cih of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;c-#c7 is amended-- 7#a7 in the section heading1 by striking ,establishment of program and inserting ,cooperative agreements to ,states and public health departments for ,alzheimer's disease and related dementias2 7#b7 by striking subsection 7a7 and inserting the following3 7a7 ,in general ,the ,secretary1 in coordination with the ,director of the ,centers for ,disease ,control and ,prevention and the heads of other agencies1 as appropriate1 shall award cooperative agreements to health departments of ,states1 political subdivisions of ,states1 and ,indian tribes and tribal organizations1 to address ,alzheimer's disease and related dementias1 including by reducing cognitive decline1 helping meet the needs of caregivers1 and addressing unique aspects of ,alzheimer's disease and related dementias to support the development and implementation of evidence-based interventions with respect to-- 7#a7 educating and informing the public1 based on evidence-based public health research and data1 about ,alzheimer's disease and related dementias2 7#b7 supporting early detection and diagnosis2 7#c7 reducing the risk of potentially avoidable hospitalizations for individuals with ,alzheimer's disease and related dementias2 7#d7 reducing the risk of cognitive decline and cognitive impairment associated with ,alzheimer's disease and related dementias2 7#e7 improving support to meet the needs of caregivers of individuals with ,alzheimer's disease and related dementias2 7#f7 supporting care planning and management for individuals with ,alzheimer's disease and related dementias4 7#g7 supporting other relevant activities identified by the ,secretary or the ,director of the ,centers for ,disease ,control and ,prevention1 as appropriate 42 and 7#c7 by striking subsection 7b72 7#d7 by redesignating subsection 7c7 as subsection 7g72 7#e7 by inserting after subsection 7a71 the following3 7b7 ,preference ,in awarding cooperative agreements under this section1 the ,secretary shall give preference to applications that focus on addressing health disparities1 including populations and geographic areas that have the highest prevalence of ,alzheimer's disease and related dementias4 7c7 ,eligibility ,to be eligible to receive a cooperative agreement under this section1 an eligible entity 7pursuant to subsection 7a77 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 and evaluation with respect to ,alzheimer's disease and related dementias1 and in the case of a cooperative agreement under this section1 how the applicant proposes to support other relevant activities identified by the ,secretary or ,director of the ,centers for ,disease ,control and ,prevention1 as appropriate4 7#b7 the manner in which the applicant will coordinate with ,federal1 tribal1 and ,state programs related to ,alzheimer's disease and related dementias1 and appropriate ,state1 tribal1 and local agencies1 as well as other 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 7d7 ,matching requirement ,each health department that is awarded a cooperative agreement under subsection 7a7 shall provide1 from non-,federal sources1 an amount equal to #cj 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 7e7 ,waiver authority ,the ,secretary may waive all or part of the matching requirement described in subsection 7d7 for any fiscal year for-- 7#a7 a health department of a ,state1 political subdivision of a ,state1 or ,indian tribe and tribal organization1 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 ,state1 political subdivision of a ,state1 or ,indian tribe and tribal organization2 or 7#b7 a health department of a ,state1 political subdivision of a ,state1 or ,indian tribe and tribal organization located in a rural area or frontier area4 2 7#f7 in subsection 7f7 7as so redesignated71 by striking grant and inserting cooperative agreement2 and 7#g7 by adding at the end the following3 7f7 ,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-- 7#a7 activities of centers of excellence with respect to ,alzheimer's disease and related dementias described in section #cih;,a2 and 7#b7 activities of public health departments with respect to ,alzheimer's disease and related dementias described in this section4 4 #d4 ,additional provisions ,section #cih;,b of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;c-#e7 is amended-- 7#a7 in subsection 7a7-- 7,a7 by inserting or cooperative agreement after grant each place that such appears2 7,b7 by striking section #cih7;a7 to a ,state unless the ,state and inserting sections #cih or #cih;,a to an entity unless the entity2 and 7,c7 by striking #aj and inserting #e2 7#b7 by striking subsection 7b72 7#c7 by redesignating subsections 7c7 and 7d7 as subsections 7b7 and 7c71 respectively2 7#d7 in subsection 7b7 7as so redesignated7-- 7,a7 in the matter preceding paragraph 7#a71 by striking section #cih7;a7 to a ,state unless the ,state and inserting sections #cih or #cih;,a to an entity unless the entity2 7,b7 in paragraph 7#a71 by striking expenditures required in subsection 7b72 and inserting expenditures22 7#e7 in subsection 7c7 7as so redesignated7-- 7,a7 in paragraph 7#a7-- 7i7 by striking each demonstration project for which a grant and inserting the activities for which an award2 and 7ii7 by striking section #cih7;a7 and inserting sections #cih or #cih;,a2 and 7,b7 in paragraph 7#b71 by striking #f months and inserting #a year2 7#f7 by inserting after subsection 7c7 7as so redesignated71 the following3 7d7 ,definition ,in this subpart1 the terms #8,indian tribe' and #8tribal organization' have the meanings given such terms in section #d of the ,indian ,health ,care ,improvement ,act4 2 and 7#g7 in subsection 7e71 by striking #e1jjj1jjj for each of the fiscal years #aihh through #aiij and all that follows through #bjjb and inserting #bj1jjj1jjj for each of fiscal years #bjbj through #bjbd4 ,november #bi1 #bjah,reported with an amendment