,i #aafth ,,congress #ast ,session ,h4 ,r4 #bbhc ,,in ,,the ,,house ,,of ,,representatives ,april #aj1 #bjai,ms4 ,snchez 7for herself1 ,mr4 ,la,hood1 ,ms4 ,matsui1 and ,mrs4 ,rodgers of ,washington7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to provide better care and outcomes for ,americans living with ,alzheimer's disease and related dementias and their caregivers while accelerating progress toward prevention strategies1 disease modifying treatments1 and1 ultimately1 a cure4 #a4 ,short title2 table of contents2 findings 7a7 ,short title ,this ,act may be cited as the ,concentrating on ,high-value ,alzheimer's ,needs to ,get to an ,end ,act of #bjai or the ,,change ,act of #bjai4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents2 findings4 ,sec4 #b4 ,cognitive impairment detection benefit in the ,medicare annual wellness visit and initial preventive physical examination4 ,sec4 #c4 ,medicare quality payment program4 ,sec4 #d4 ,report to ,congress on implementation of this ,act4 ,sec4 #e4 ,study and report on regulatory and legislative changes or refinements that would accelerate ,alzheimer's disease research progress4 7c7 ,findings ,congress finds as follows3 7#a7 ,it is estimated that #e4h million ,americans are living with ,alzheimer's disease in #bjai4 ,this includes an estimated #e4f million people age #fe and older and approximately #bjj1jjj individuals under age #fe who have younger-onset ,alzheimer's4 ,by #bjej1 the number of people age #fe and older with ,alzheimer's dementia is projected to increase to #ac4h million ,americans4 7#b7 ,as many as half of the estimated #e1ajj1jjj ,american seniors with ,alzheimer's disease and other dementias have never received a diagnosis4 7#c7 ,in #bjai1 it is estimated that ,alzheimer's and related dementias will have cost the ,medicare and ,medicaid programs #aie billion4 ,by #bjej1 it is estimated that these direct costs will increase to as much as #a4a trillion4 7#d7 ,alzheimer's exacts an emotional and physical toll on caregivers1 resulting in higher incidence of heart disease1 cancer1 depression1 and other health consequences4 7#e7 ,alzheimer's disease disproportionately impacts women and people of color4 ,women are twice as likely to develop ,alzheimer's as they are breast cancer4 ,african ,americans are about two times more likely than ,white ,americans to have ,alzheimer's disease and other dementias4 ,latinos are about one and one-half times more likely than ,white ,americans to have ,alzheimer's disease and other dementias4 ,according to the ,centers for ,disease ,control and ,prevention1 among people ages #fe and older1 ,african ,americans have the highest prevalence of ,alzheimer's disease and related dementias 7#ac4h percent71 followed by ,hispanics 7#ab4b percent71 and non-,hispanic ,whites 7#aj4c percent71 ,american ,indian and ,alaska ,natives 7#i4a percent71 and ,asian and ,pacific ,islanders 7#h4d percent74 ,this higher prevalence translates into a higher death rate3 ,alzheimer's deaths increased #ee percent among all ,americans between #aiii and #bjad1 while the number was #ajg percent for ,latinos and #ii percent for ,african ,americans4 7#f7 ,there are evidence-based1 reliable1 and ,,nih-identified cognitive impairment detection tools available at the ,national ,institute on ,aging's ,alzheimer's and ,dementia ,resources for ,professionals website that must replace detection by direct observation in the ,medicare ,annual visits and ,welcome to ,medicare visits4 ,the ,,nih-identified tools will allow for appropriate follow-up instead of delaying diagnosis or impeding opportunities for patients to access timely treatment options1 including clinical trial participation4 7#g7 ,an early1 documented diagnosis1 communicated to the patient and caregiver1 enables early access to care planning services and available medical and nonmedical treatments1 and optimizes patients' ability to build a care team1 participate in support services1 and enroll in clinical trials4 7#h7 ,african ,americans represent #ac percent of the population of the ,united ,states but only #e percent of clinical trial participants1 and ,latinos represent #ag percent of the population of the ,united ,states but less than one percent of clinical trial participants4 ,further1 ,latinos and ,african ,americans account for only #c4e percent and #a4b percent1 respectively1 of principal investigators supported by the ,national ,institutes of ,health funding1 limiting this perspective in research4 ,better recruitment and trial designs are critical to addressing innovation in ,alzheimer's generally1 including the underrepresentation of ,african ,americans and ,latinos4 7#i7 ,inability to identify eligible patients at the earliest stages of disease is a substantial impediment to efficient research toward ,alzheimer's disease prevention1 treatment1 and cure4 7#aj7 ,advancing treatment options to prevent1 treat1 or cure ,alzheimer's is an urgent national priority4 7#aa7 ,a paradigm shift to drive synergies between high-value patient care1 caregiver support1 brain health promotion1 and research initiatives is our best hope for preventing1 treating1 and curing ,alzheimer's disease4 #b4 ,cognitive impairment detection benefit in the ,medicare annual wellness visit and initial preventive physical examination 7a7 ,annual wellness visit 7#a7 ,in general ,section #ahfa7;hhh77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7hhh77#b77 is amended-- 7,a7 by striking subparagraph 7,d7 and inserting the following3 7,d7 ,detection of any cognitive impairment or progression of cognitive impairment that shall-- 7i7 be performed using a cognitive impairment detection tool identified by the ,national ,institute on ,aging as meeting its criteria for selecting instruments to detect cognitive impairment in the primary care setting1 and other validated cognitive detection tools as the ,secretary determines2 7ii7 include documentation of the tool used for detecting cognitive impairment and results of the assessment in the patient's medical record2 and 7iii7 take into consideration the tool used1 and results of1 any previously performed cognitive impairment detection assessment4 2 7,b7 by redesignating subparagraph 7,i7 as subparagraph 7,j72 and 7,c7 by inserting after subparagraph 7,h7 the following new subparagraph3 7,i7 ,referral of patients with detected cognitive impairment or potential cognitive decline to-- 7i7 appropriate ,alzheimer's disease and dementia diagnostic services1 including amyloid positron emission tomography1 and other medically accepted diagnostic tests that the ,secretary determines are safe and effective2 7ii7 specialists and other clinicians with expertise in diagnosing or treating ,alzheimer's disease and related dementias2 7iii7 available community-based services1 including patient and caregiver counseling and social support services2 and 7iv7 appropriate clinical trials4 4 7#b7 ,effective date ,the amendments made by paragraph 7#a7 shall apply to annual wellness visits furnished on or after ,january #a1 #bjbj4 7b7 ,initial preventive physical examination 7#a7 ,in general ,section #ahfa7ww77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7ww77#a77 is amended by striking agreement with the individual1 and and inserting agreement with the individual1 detection of any cognitive impairment or progression of cognitive impairment as described in subparagraph 7,d7 of subsection 7hhh77#b7 and referrals as described in subparagraph 7,i7 of such subsection1 and4 7#b7 ,effective date ,the amendments made by paragraph 7#a7 shall apply to initial preventive physical examinations furnished on or after ,january #a1 #bjbj4 #c4 ,medicare quality payment program ,not later than ,january #a1 #bjbj1 the ,secretary of ,health and ,human ,services shall implement ,medicare policies under title ,,xviii of the ,social ,security ,act1 including quality measures and ,medicare ,advantage plan rating and risk adjustment mechanisms1 that reflect the public health imperative of-- 7#a7 promoting healthy brain lifestyle choices2 7#b7 identifying and responding to patient risk factors for ,alzheimer's disease and related dementias2 and 7#c7 incentivizing providers for-- 7,a7 adequate and reliable cognitive impairment detection in the primary care setting1 that is documented in the patient's electronic health record and communicated to the patient2 7,b7 timely ,alzheimer's disease diagnosis2 and 7,c7 appropriate care planning services1 including identification of1 and communication with patients and caregivers about1 the potential for clinical trial participation4 #d4 ,report to ,congress on implementation of this ,act ,not later than #c years after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall submit a report to ,congress on the implementation of the provisions of1 and amendments made by1 this ,act1 including-- 7#a7 the increased use of validated tools for detection of cognitive impairment and ,alzheimer's disease2 7#b7 utilization of ,alzheimer's disease diagnostic and care planning services2 and 7#c7 outreach efforts in the primary care and patient communities4 #e4 ,study and report on regulatory and legislative changes or refinements that would accelerate ,alzheimer's disease research progress 7a7 ,in general ,the ,comptroller ,general of the ,united ,states 7in this section referred to as the ,comptroller ,general7 shall conduct a study on regulatory and legislative changes or refinements that would accelerate ,alzheimer's disease research progress4 ,in conducting such study1 the ,comptroller ,general shall consult with interested stakeholders1 including industry leaders1 researchers1 clinical experts1 patient advocacy groups1 caregivers1 patients1 providers1 and ,state leaders4 ,such study shall include an analysis of innovative public-private partnerships1 innovative financing tools1 incentives1 and other mechanisms to enhance the quality of care for individuals diagnosed with ,alzheimer's disease1 reduce the emotional1 financial1 and physical burden on familial care partners1 and accelerate development of preventative1 curative1 and disease-modifying therapies4 7b7 ,report ,not later than #a year after the date of the enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report containing the results of the study conducted under subsection 7a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4