,,ii  #aae? ,,congress  #b;d ,session   
,s4 #bchg  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,febru>y #g1 #bjah,mrs4
 ,capito 7= h]self1 ,ms4 ,/ab5[1 ,mr4   
,wick]1 & ,mr4 ,m55dez7 introduc$ !     
foll[+ bill2 :i* 0 read twice & ref]r$  
to ! ,committee on ,f9ance  ,a ,,bill   
,to provide bett] c>e & outcomes =      
,am]icans liv+ ) ,alzheim]'s disease &  
relat$ dem5tias & _! c>egiv]s :ile      
accel]at+ progress t[>d prev5tion       
/rategies1 disease modify+ treatm5ts1 &1
 ultimately1 a cure4  #a4 ,%ort title2  
table ( cont5ts2 f9d+s  7a7 ,%ort title 
,?is ,act may be cit$ z ! ,conc5trat+ on
 ,high-value ,alzheim]'s ,ne$s to ,get  
to an ,end 7,,*ange7 ,act ( #bjah4  7b7 
,table ( cont5ts ,! table ( cont5ts (   
?is ,act is z foll[s3 ,sec4 #a4 ,%ort   
title2 table ( cont5ts2 f9d+s4 ,sec4 #b4
 ,cognitive impairm5t detection b5efit 9
 ! ,m$ic>e annual wellness visit &      
initial prev5tive physical exam9ation4  
,sec4 #c4 ,te/ ( c>e deliv]y models (f]+
 a cont9uum ( compreh5sive c>e1 &       

c>egiv] support s]vices1 = pati5ts )    
,alzheim]'s disease & o!r dem5tias4     
,sec4 #d4 ,/ate innovation models =     
family c>egiv]s ( pati5ts ) ,alzheim]'s 
& relat$ dem5tias4 ,sec4 #e4 ,m$ic>e    
quality paym5t program4 ,sec4 #f4       
,report to ,congress on implem5tation ( 
?is ,act4 ,sec4 #g4 ,/udy & report on   
regulatory & legislative *anges or      
ref9em5ts t w\ld accel]ate ,alzheim]'s  
disease rese>* progress4  7c7 ,f9d+s    
,congress f9ds z foll[s3  7#a7 ,! numb] 
( individuals 9 ! ,unit$ ,/ates )       
,alzheim]'s disease & relat$ dem5tias   
has m ?an d\bl$ s9ce #aihj &1 bas$ on ! 
trajectory ( ,alzheim]'s1 z _m z #ad to 
#af million individuals 9 ! ,unit$      
,/ates w h ,alzheim]'s by #bjej4  7#b7  
,alzheim]'s is ! only disease among !   
top #aj causes ( dea? 9 ! ,unit$ ,/ates 
)\t an effective means ( prev5tion1     
treatm5t1 or cure4  7#c7 ,9 #bjag1      
,alzheim]'s c>e w co/ ,m$ic>e & ,m$icaid
 an e/imat$ #age1jjj1jjj1jjj & by #bjej1
 ,alzheim]'s disease w co/ ,m$ic>e &    

,m$icaid z mu* z #geh1jjj1jjj1jjj4  7#d7
 ,alzheim]'s exacts an emotional &      
physical toll on c>egiv]s1 result+ 9    
high] incid5ce ( he>t disease1 canc]1   
depression1 & o!r heal? consequ5ces4    
7#e7 ,alzheim]'s disease                
disproportionately impacts wom5 & p (   
color4 ,wom5 are twice z likely to      
develop ,alzheim]'s z !y are brea/      
canc]4 ,african ,am]icans are ab\t two  
times m likely ?an ,:ite ,am]icans to h 
,alzheim]'s disease & o!r dem5tias4     
,lat9os are ab\t "o & "o-half times m   
likely ?an ,:ite ,am]icans to h         
,alzheim]'s disease & o!r dem5tias4 ,?is
 high] preval5ce translates into a high]
 dea? rate3 ,alzheim]'s dea?s increas$  
#ee p]c5t among all ,am]icans betwe5    
#aiii & #bjad1 :ile ! numb] 0 #ajg p]c5t
 = ,lat9os & #ii p]c5t = ,african       
,am]icans4  7#f7 ,z _m z half ( !       
e/imat$ #e1ajj1jjj ,am]ican s5iors )    
,alzheim]'s disease & o!r dem5tias h    
nev] receiv$ a diagnosis4  7#g7 ,an     
e>ly1 docum5t$ diagnosis1 communicat$ to

 ! pati5t & c>egiv]1 enables e>ly access
 to c>e plann+ s]vices & available      
m$ical & nonm$ical treatm5ts1 &         
optimizes pati5ts' ability to build a   
c>e team1 p>ticipate 9 support s]vices1 
& enroll 9 cl9ical trials4  7#h7 ,! lack
 ( uni=m1 reliable cognitive impairm5t  
detection me?odologies 9 ! ,m$ic>e      
annual wellness visit1 & appropriate    
foll[-up1 delays diagnosis1 result+ 9   
decreas$ opportunities = pati5ts to     
access timely treatm5t options1 includ+ 
cl9ical trial p>ticipation4  7#i7       
,african ,am]icans repres5t #ac p]c5t ( 
! ,u4,s4 population b only #e p]c5t (   
cl9ical trial p>ticipants & ,lat9os     
repres5t #ag p]c5t ( ! ,u4,s4 population
 b less ?an "o p]c5t ( cl9ical trial    
p>ticipants4 ,fur!r1 ,lat9os & ,african 
,am]icans acc\nt = only #c4e p]c5t &    
#a4b p]c5t1 respectively1 ( pr9cipal    
inve/igators support$ by ! ,national    
,in/itutes ( ,heal? fund+1 limit+ ?is   
p]spective 9 rese>*4 ,bett] recruitm5t &
 trial designs are critical to address+ 

innovation 9 ,alzheim]'s g5]ally1       
includ+ ! und]repres5tation ( ,african  
,am]icans & ,lat9os4  7#aj7 ,inability  
to id5tify eligible pati5ts at ! e>lie/ 
/ages ( disease is a sub/antial imp$im5t
 to effici5t rese>* t[>d ,alzheim]'s    
disease prev5tion1 treatm5t1 & cure4    
7#aa7 ,advanc+ treatm5t options to      
prev5t1 treat1 or cure ,alzheim]'s is an
 urg5t national priority4  7#ab7        
,cont9u$ ,f$]al inve/m5t 9 ,alzheim]'s  
rese>* & ! implem5tation ( innovative   
programs1 su* z ! break?r\gh ,,eureka   
prize competition au?oriz$ 9 ! #ba/     
,c5tury ,cures ,act1 are critical to    
advance ! se>* to id5tify1 treat1 cure1 
& prev5t ,alzheim]'s disease4  7#ac7    
,exi/+ heal? c>e sy/ems-- 7,a7 are      
co/ly2  7,b7 d n adequately meet ! ne$s 
( ,alzheim]'s pati5ts2  7,c7 ov]burd5   
familial c>egiv]s2 &  7,d7 p]petuate    
hurdles to effici5t ,alzheim]'s rese>*4 
7#ad7 ,a p>adigm %ift to drive syn]gies 
betwe5 high-value pati5t c>e1 c>egiv]   
support1 & rese>* initiatives is our be/

 hope = prev5t+1 treat+1 & cur+         
,alzheim]'s disease4  7#ae7 ,section    
#aaae;,a ( ! ,social ,security ,act1 z  
am5d$ by ! ,,pace ,innovation ,act (    
#bjae1 enables id5tification (          
,alzheim]'s disease c>e models t focus  
on improv+ pati5t-c5t]$ outcomes1 r$uce 
! burd5 on in=mal & familial c>egiv]s1 &
 facilitate cl9ical trial p>ticipation4 
#b4 ,cognitive impairm5t detection      
b5efit 9 ! ,m$ic>e annual wellness visit
 & initial prev5tive physical exam9ation
  7a7 ,annual wellness visit  7#a7 ,9   
g5]al ,section #ahfa7;hhh77#b7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#aciex7hhh77#b77 is am5d$-- 7,a7 by     
/rik+ subp>agraph 7,d7 & ins]t+ !       
foll[+3  7,d7 ,detection ( any cognitive
 impairm5t or progression ( cognitive   
impairm5t t %all-- 7i7 be p]=m$ us+ a   
cognitive impairm5t detection tool      
id5tifi$ by ! ,national ,in/itute on    
,ag+ z meet+ its crit]ia = select+      
in/rum5ts to detect cognitive impairm5t 
9 ! prim>y c>e sett+1 & o!r validat$    

cognitive detection tools z ! ,secret>y 
det]m9es2  7ii7 include docum5tation ( !
 tool us$ = detect+ cognitive impairm5t 
& results ( ! assessm5t 9 ! pati5t's    
m$ical record2 &  7iii7 take into       
consid]ation ! tool us$1 & results (1   
any previ\sly p]=m$ cognitive impairm5t 
detection assessm5t4  2  7,b7 by        
r$esignat+ subp>agraph 7,g7 z           
subp>agraph 7,h72 &  7,c7 by ins]t+ aft]
 subp>agraph 7,f7 ! foll[+ new          
subp>agraph3  7,g7 ,ref]ral ( pati5ts ) 
detect$ cognitive impairm5t or pot5tial 
cognitive decl9e to-- 7i7 appropriate   
,alzheim]'s disease & dem5tia diagno/ic 
s]vices1 includ+ amyloid positron       
emission tomography1 & o!r m$ically     
accept$ diagno/ic te/s t ! ,secret>y    
det]m9es are safe & effective2  7ii7    
speciali/s & o!r cl9icians ) exp]tise 9 
diagnos+ or treat+ ,alzheim]'s disease &
 relat$ dem5tias2  7iii7 available      
community-bas$ s]vices1 includ+ pati5t &
 c>egiv] c\nsel+ & social support       
s]vices2 &  7iv7 appropriate cl9ical    

trials4  4  7#b7 ,effective date ,!     
am5dm5ts made by p>agraph 7#a7 %all     
apply to annual wellness visits furni%$ 
on or aft] ,janu>y #a1 #bjai4  7b7      
,initial prev5tive physical exam9ation  
7#a7 ,9 g5]al ,section #ahfa7ww77#a7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#aciex7ww77#a77 is am5d$ by /rik+       
p>agraph 7#b7 & & ins]t+ p>agraph 7#b71 
detection ( any cognitive impairm5t or  
progression ( cognitive impairm5t z     
describ$ 9 subp>agraph 7,d7 ( subsection
 7hhh77#b7 & ref]rals z describ$ 9      
subp>agraph 7,g7 ( su* subsection1 &4   
7#b7 ,effective date ,! am5dm5ts made by
 p>agraph 7#a7 %all apply to initial    
prev5tive physical exam9ations furni%$  
on or aft] ,janu>y #a1 #bjai4  #c4 ,te/ 
( c>e deliv]y models (f]+ a cont9uum (  
compreh5sive c>e1 & c>egiv] support     
s]vices1 = pati5ts ) ,alzheim]'s disease
 & o!r dem5tias ,section #aaae;,a ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acae;a7 is am5d$-- 7#a7 9 subsection   
7b77#b77;,a71 by add+ at ! end ! foll[+ 

new s5t5ce3 ,! models select$ "u ?is    
subp>agraph %all include ! model        
describ$ 9 subsection 7h71 :i* %all be  
implem5t$ by n lat] ?an #f mon?s aft] ! 
date ( ! enactm5t ( ! ,conc5trat+ on    
,high-value ,alzheim]'s ,ne$s to ,get to
 an ,end 7,,*ange7 ,act ( #bjah42  7#b7 
by add+ at ! end ! foll[+ new           
subsection3  7h7 ,deliv]y models (f]+ a 
cont9uum ( compreh5sive c>e1 & c>egiv]  
support s]vices1 = pati5ts ) ,alzheim]'s
 disease & o!r dem5tias  7#a7 ,9 g5]al  
,! models describ$ 9 ?is subsection are 
,m$ic>e1 ,m$icaid1 or multi-pay] models 
t incorporate a compreh5sive cont9uum ( 
c>e framework1 su* z t conta9$ 9 !      
,program ( ,all-,inclusive ,c>e = !     
,eld]ly 7,,pace71 to individuals        
diagnos$ ) ,alzheim]'s disease or relat$
 dem5tia1 at any /age4  7#b7            
,requirem5ts = models ,! models describ$
 9 ?is subsection %all include ! foll[+3
 7,a7 ,! enrollm5t ( pati5ts diagnos$ ) 
,alzheim]'s disease1 at any /age1 )\t   
reg>d to m$ical ne$ = skill$ nurs+      

facility c>e or ,m$icaid eligibility4   
7,b7 ,?r\gh case managem5t & c>e        
coord9ation s]vices1 ! (f]+ ( a flexible
 m5u ( s]vices1 bas$ ^u id5tifi$ pati5t 
ne$s ov] "t1 = high-quality1 appropriate
 c>e f diagnosis ?r\gh disease          
progression1 includ+ id5tification (    
appropriate cl9ical trials4  7,c7 ,!    
employm5t ( a compreh5sive approa* to   
c>+ = pati5ts ) ,alzheim]'s disease or  
relat$ dem5tia t integrates treatm5t (  
su* pati5ts ) tra9+ & support s]vices = 
_! families & c>egiv]s1 & facilitates   
p>ticipation 9 cl9ical trials4 ,su*     
s]vices may include--  7i7 day heal?c>e1
 includ+ heal? c>e s]vices &            
dem5tia-specific social1 rehabilitative1
 recreational1 memory1 ex]cise1         
nutritional c\nsel+1 occupational !rapy1
 & p]sonal c>e s]vices2  7ii7 physician 
c>e1 includ+ ref]r$ speciali/s2  7iii7  
respite c>e &1 = cl9ical trial          
p>ticipants1 c>e p>tn] surrogate s]vices
 z ne$$2  7iv7 m$ications & m$ication   
managem5t1 includ+ = cl9ical trial      

compliance2  7v7 nurs+ c>e1 &           
occupational1 physical1 & spee* !rapy z 
prescrib$2  7vi7 id5tification &        
managem5t ( comorbidities2  7vii7 social
 work] s]vices2  7viii7 meals at day    
heal? c>e &1 if ne$$1 at home2  7ix7    
transportation to & f day heal? c>e &   
cl9ical trial /udy visits2 &  7x7       
p]sonal c>e1 skill$ nurs+ s]vices1 & o!r
 s]vices ! ,secret>y det]m9es           
appropriate t--  7,i7 incorporate       
c>egiv] tra9+1 support1 & c\nsel+       
s]vices successfully evaluat$ &         
implem5t$ 9 previ\s or exi/+ models te/$
 "u su* section #aaae;,a & t are        
specific to ,alzheim]'s disease pati5ts 
& _! c>egiv]s2  7,,ii7 ma9ta9           
docum5tation & data likely to fur!r     
sci5tific und]/&+ ( ,alzheim]'s disease 
natural hi/ory1 tak+ into acc\nt g5d]1  
race1 e?nicity1 age ( onset1 & o!r      
factors2 &  7,,iii7 provide outrea*     
activities to in=m ! public ( ! s]vices 
( ! program1 & provide in=mation on     
,alzheim]'s disease & relat$ dem5tias to

 ! prim>y c>e community & g5]al public4 
7#c7 ,model selection & evaluation  7,a7
 ,reque/s = proposals ,9 implem5t+ !    
models describ$ 9 ?is subsection1 !     
,secret>y %all seek reque/s = proposals 
f ,/ates1 ,,pace programs 7z def9$ 9    
section #ahid7;a77#b771 ,alzheim]'s     
disease & dem5tia c>e c5t]s1 &          
specializ$ ,,ma plans = special ne$s    
individuals 7z def9$ 9 section          
#ahei7;b77#f77 t h ! demon/rat$ ability 
to deliv] ! compreh5sive cont9uum (     
dem5tia c>e describ$ 9 p>agraph 7#b74   
7,b7 ,phase ,i models ,9 select+ models 
"u ?is subsection to be te/$ "u         
subsection 7b71 & 9 evaluat+ models1 !  
,secret>y %all prim>ily focus on pati5t 
& c>egiv] outcomes1 su* z--  7i7 improv$
 quality ( life2  7ii7 ma9ta9+          
functional or cognitive p]=mance2  7iii7
 managem5t ( comorbidities & behavioral 
& safety conc]ns2 &  7iv7 cont9u$       
ability to rema9 9 ! community4  7,c7   
,phase ,,ii ,subject to ! requirem5ts "u
 subsection 7c71 9 det]m9+ :i* models "u

 ?is subsection to exp& "u subsection   
7c71 ! ,secret>y %all take into acc\nt--
  7i7 any recomm5dations or /rategies   
id5tifi$ 9 ! report "u section #h ( !   
,conc5trat+ on ,high-value ,alzheim]'s  
,ne$s to ,get to an ,end 7,,*ange7 ,act 
( #bjah2 &  7ii7 :e!r ! model           
incorporates c>e deliv]y1 paym5t1 &     
evaluation /rategies t are likely to    
demon/rate improv$ pati5t outcomes1     
includ+ ! outcomes describ$ 9           
subp>agraph 7,b7 & r$uc$                
hospitalizations1 em]g5cy room visits1 &
 skill$ nurs+ facility /ays1 )\t        
increas+ sp5d+ "u ! applicable title4  4
  #d4 ,/ate innovation models = family  
c>egiv]s ( pati5ts ) ,alzheim]'s &      
relat$ dem5tias ,section                
#aaae;,a7b77#b77;,b7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#acae7;b77#b77;,b77 is am5d$ by add+ !  
foll[+ new clause3  7xxv7 ,all[+ ,/ates 
to develop & te/ programs t increase an 
,alzheim]'s disease pati5t's ability to 
rema9 9 ! community by r$uc+ ! f9ancial 

burd5 to family c>egiv]s1 & t include-- 
7,i7 familial c>egiv] support s]vices1  
includ+ tra9+ necess>y to enable su*    
c>egiv]s to provide s]vices at ! level (
 a home heal? aide2  7,,ii7 c]tification
 ( familial c>egiv] tra9+ & satisfactory
 completion ( te/+ or o!r requirem5ts   
demon/rat+ c>egiv] compet5ce2  7,,iii7  
appropriate familial c>egiv] ov]sight1  
includ+ home visits or o!r activities2 &
  7,,iv7 = familial c>egiv]s (          
,alzheim]'s disease & o!r dem5tia       
pati5ts = :om a c>e plan includes home  
heal? aide s]vices1 paym5t to ! c>egiv] 
= ! h\rs ( "o-on-"o s]vices provid$ 9 ! 
c>e plan1 & p]=m$ by ! familial         
c>egiv]s1 9 an am\nt t is n bel[ !      
!n-applicable m9imum wage 9 t ,/ate &   
does n exce$ ! prevail+ h\rly rate paid 
to a home heal? aide4  4  #e4 ,m$ic>e   
quality paym5t program ,n lat] ?an      
,janu>y #a1 #bjai1 ! ,secret>y ( ,heal? 
& ,human ,s]vices %all implem5t ,m$ic>e 
policies "u title ,,xviii ( ! ,social   
,security ,act1 includ+ quality measures

 & ,m$ic>e ,advantage plan rat+ & risk  
adju/m5t me*anisms1 t reflect ! public  
heal? imp]ative (--  7#a7 promot+ heal?y
 bra9 life/yle *oices2  7#b7 id5tify+ & 
respond+ to pati5t risk factors =       
,alzheim]'s disease & relat$ dem5tias2 &
  7#c7 inc5tiviz+ provid]s =-- 7,a7     
adequate & reliable cognitive impairm5t 
detection 9 ! prim>y c>e sett+1 t is    
docum5t$ 9 ! pati5t's electronic heal?  
record & communicat$ to ! pati5t2  7,b7 
timely ,alzheim]'s disease diagnosis2 & 
7,c7 appropriate c>e plann+ s]vices1    
includ+ id5tification (1 & communication
 ) pati5ts & c>egiv]s ab\t1 ! pot5tial =
 cl9ical trial p>ticipation4  #f4       
,report to ,congress on implem5tation ( 
?is ,act ,n lat] ?an #c ye>s aft] ! date
 ( ! enactm5t ( ?is ,act1 ! ,secret>y ( 
,heal? & ,human ,s]vices %all submit a  
report to ,congress on ! implem5tation (
 ! provisions (1 & am5dm5ts made by1 ?is
 ,act1 includ+--  7#a7 ! increas$ use ( 
validat$ tools = detection ( cognitive  
impairm5t & ,alzheim]'s disease2  7#b7  

models und]go+ te/+ & evaluation "u !   
provisions (1 & am5dm5ts made by1       
sections #c & #d2  7#c7 utilization (   
,alzheim]'s disease diagno/ic & c>e     
plann+ s]vices2 &  7#d7 outrea* ef=ts 9 
! prim>y c>e & pati5t communities4  #g4 
,/udy & report on regulatory &          
legislative *anges or ref9em5ts t w\ld  
accel]ate ,alzheim]'s disease rese>*    
progress  7a7 ,9 g5]al ,! ,comptroll]   
,g5]al ( ! ,unit$ ,/ates 79 ?is section 
ref]r$ to z ! ,comptroll] ,g5]al7 %all  
conduct a /udy on regulatory &          
legislative *anges or ref9em5ts t w\ld  
accel]ate ,alzheim]'s disease rese>*    
progress4 ,9 conduct+ su* /udy1 !       
,comptroll] ,g5]al %all consult )       
int]e/$ /akehold]s1 includ+ indu/ry     
lead]s1 rese>*]s1 cl9ical exp]ts1 pati5t
 advocacy gr\ps1 c>egiv]s1 pati5ts1     
provid]s1 & ,/ate lead]s4 ,su* /udy %all
 include an analysis (--  7#a7          
innovative public-private p>tn]%ips1    
innovative f9anc+ tools1 inc5tives & o!r
 me*anisms to enhance ! quality ( c>e = 

individuals diagnos$ ) ,alzheim]'s      
disease1 r$uce ! emotional1 f9ancial1 & 
physical burd5 on familial c>e p>tn]s1 &
 accel]ate developm5t ( prev5tative1    
curative1 & disease-modify+ !rapies2 &  
7#b7 ! results ( any models "u !        
provisions (1 & am5dm5ts made by1       
sections #c & #d & ! feasibility (      
incorporat+ into su* models innovative  
arrangem5ts ) rese>* sponsors1 ?r\gh a  
us] fee or o!rwise1 to facilitate budget
 neutrality or inc5tivize provid]s ?r\gh
 a %>$-sav+s approa*4  7b7 ,report ,n   
lat] ?an #a ye> aft] ! date ( ! enactm5t
 ( ?is ,act1 ! ,comptroll] ,g5]al %all  
submit to ,congress a report conta9+ !  
results ( ! /udy conduct$ "u subsection 
7a71 toge!r ) recomm5dations = su*      
legislation & adm9i/rative action z !   
,comptroll] ,g5]al det]m9es appropriate4