,,ii #aafth ,,congress #ast ,session ,s4 #aabf ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,april #aj1 #bjai ,mrs4 ,capito 7for herself1 ,ms4 ,stabenow1 ,mr4 ,wicker1 and ,mr4 ,menendez7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to provide better care and outcomes for ,americans living with ,alzheimer's disease and related dementias and their caregivers1 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 7,,change7 ,act of #bjai4 7b7 ,table of contents ,the table of contents for 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 implementation4 7c7 ,findings ,congress finds the following3 7#a7 ,it is estimated that #e1hjj1jjj million ,americans are living with ,alzheimer's disease in #bjai4 ,this includes an estimated #e1fjj1jjj 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 #ac1hjj1jjj ,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 expected that ,alzheimer's and related dementias will cost ,medicare and ,medicaid #aie1jjj1jjj1jjj4 ,by #bjej1 it is estimated that overall ,alzheimer's costs will increase to more than #a1ajj1jjj1jjj1jjj4 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 #b times more likely than ,white ,americans to have ,alzheimer's disease and other dementias4 ,latinos are about #aa_/b times more likely than ,white ,americans to have ,alzheimer's disease and other dementias4 ,according to the ,centers for ,disease ,control1 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 ,the latest science reveals there are actions that can be taken both now and across the lifespan of an individual to help optimize brain health1 reduce the risk of cognitive decline1 and help mitigate symptoms4 ,there are also important behavioral and social dimensions that could delay cognitive decline and build a resilient brain4 ,for example1 a #bjaf study supported by the ,national ,institutes of ,health found that a diet high in natural plant-based foods and limited in saturated fats was associated with reduced cognitive decline4 ,a #bjag study published by the ,lancet ,commission found that physical activity had a significant protective effect against cognitive decline4 ,a study supported by the ,national ,institutes of ,health which was published in #bjah found a connection between lower blood pressure and decreased cognitive impairment4 ,an ,american ,academy of ,neurology study recently published found that physical activity and cognitive activity were both associated with reduced risk of total dementia4 7#g7 ,there are evidence-based1 reliable1 and ,national ,institutes of ,health-identified cognitive impairment detection tools that are available on the ,alzheimer's and ,dementia ,resources website of the ,national ,institute on ,aging that must replace detection by direct observation in the ,medicare ,annual visits and ,welcome to ,medicare visits4 ,the ,national ,institutes of ,health-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#h7 ,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 the ability of patients to build a care team1 participate in support services1 and enroll in clinical trials4 7#i7 ,african ,americans represent #ac percent of the ,united ,states population1 but only #e percent of clinical trial participants1 and ,latinos represent #ag percent of the ,united ,states population1 but less than #a 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#aj7 ,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#aa7 ,advancing treatment options to prevent1 treat1 or cure ,alzheimer's is an urgent national priority4 7#ab7 ,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 medical record of the patient2 and 7iii7 take into consideration the tool used1 and results of1 any previously performed cognitive impairment detection assessment4 2 7,b7 by moving subparagraphs 7,g7 and 7,h7 two ems to the left2 7,c7 by redesignating subparagraph 7,i7 as subparagraph 7,j72 and 7,d7 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 inserting 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 after upon the agreement with the individual14 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 ,act 7#db ,u4,s4,c4 #acie et seq471 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 electronic health record of the patient 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 regarding1 the potential for clinical trial participation4 #d4 ,report to ,congress on implementation ,not later than #c years after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall submit to ,congress a report 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