,,ii #aahth ,,congress #ast ,session ,s4 #fbf ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #b1 #bjbc,ms4 ,stabenow 7for herself and ,mrs4 ,capito7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to recommend that the ,center for ,medicare and ,medicaid ,innovation test the effect of a dementia care management model1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,comprehensive ,care for ,alzheimer's ,act4 #b4 ,,cmi testing of dementia care management ,section #aaae;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7 is amended-- 7#a7 in subsection 7b77#b77;,b71 by adding at the end the following new clause3 7xxviii7 ,furnishing comprehensive care management services to eligible individuals with ,alzheimer's disease or a related dementia through a ,dementia ,care ,management ,model1 as described in subsection 7h74 2 and 7#b7 by adding at the end the following new subsection3 7h7 ,dementia ,care ,management ,model 7#a7 ,description of model and requirements 7,a7 ,in general ,the ,dementia ,care ,management ,model described in this subsection is a model under which payments are made under title ,,xviii to eligible entities that furnish comprehensive care management services to eligible individuals with ,alzheimer's disease or a related dementia1 in order to test the effectiveness of comprehensive care management services on patient health1 care quality1 and care experience1 as well as on unpaid caregivers1 and on reducing spending under title ,,xviii without reducing the quality of care4 7,b7 ,voluntary participation ,participation under the ,dementia ,care ,management ,model shall be voluntary with respect to both eligible individuals and eligible entities4 7,c7 ,implementation of dementia care management model 7i7 ,in general ,the ,secretary shall-- 7,i7 implement the ,dementia ,care ,management ,model as a stand-alone model2 7,,ii7 incorporate the ,dementia ,care ,management ,model into the ,primary ,care ,first ,model2 or 7,,iii7 incorporate the ,dementia ,care ,management ,model into-- 7aa7 the ,primary ,care ,first ,model2 and 7bb7 the ,direct ,contracting ,model4 7ii7 ,additional authority ,in addition to the models described in subclauses 7,i7 through 7,,iii7 of clause 7i71 the ,secretary may incorporate the ,dementia ,care ,management ,model into other existing coordinated care models established under title ,,xviii or under this section1 including accountable care organizations1 value-based purchasing arrangements1 and such other coordinated care models as the ,secretary determines to be appropriate4 7#b7 ,comprehensive care management services defined ,in this subsection1 the term comprehensive care management services means the following services furnished by an eligible entity with respect to an eligible individual3 7,a7 ,continuous monitoring and assessment ,an eligible entity shall regularly assess and continuously monitor the following3 7i7 ,neuropsychiatric symptoms1 including behavior1 physical safety1 and function of an eligible individual4 7ii7 ,comorbidities4 7iii7 ,financial resources and needs4 7iv7 ,caregiver supports and resources1 including caregiver education1 training1 and support4 7v7 ,the well-being of unpaid caregivers of the eligible individual4 7vi7 ,potential risks and harms of the eligible individual's home and environment and the need for support for activities of daily living4 7,b7 ,ongoing dementia care plan ,an eligible entity shall develop and implement an ,alzheimer's disease or related dementia care plan1 including advance care planning as appropriate1 for an eligible individual4 ,the care plan shall include patient-centered goals for the eligible individual as well as goals for unpaid caregivers of the eligible individual4 ,such care plan shall be continuously evaluated and modified as appropriate4 7,c7 ,psychosocial interventions ,an eligible entity may implement psychosocial interventions designed to prevent or reduce the burden of cognitive1 functional1 behavioral1 and psychological challenges as well as the associated stress on unpaid caregivers of the eligible individual4 7,d7 ,self-management tools ,an eligible entity shall provide self-management tools to enhance the skills of the unpaid caregiver of the eligible individual to manage the ,alzheimer's disease or related dementia of the eligible individual and to navigate the health care system4 ,such tools shall include training and support for unpaid caregivers in managing the limitations of eligible individuals1 including education1 problem solving strategies1 care navigation support1 support after discharge from a hospital or nursing home1 and decision-making support4 7,e7 ,medication management ,an eligible entity shall furnish evidence-based medication review and management services to an eligible individual1 including polypharmacy management1 using a planned process to reduce or stop medications that may no longer be of benefit or may be having adverse cognitive effects1 prescribing approved medications1 and enhancing adherence to appropriate medications4 7,f7 ,treatment of related conditions ,an eligible entity shall provide interventions to prevent or treat conditions related to the ,alzheimer's disease or related dementia of the eligible individual1 such as depression and delirium4 7,g7 ,care coordination ,an eligible entity shall provide ongoing care management services and shall coordinate services and supports among providers of services and suppliers1 as well as social and community resources4 ,such services shall include necessary assistance for referrals to social and community-based organizations1 collaboration with primary care providers and the interdisciplinary team of the eligible individual1 and support for care transitions and continuity of care4 7,h7 ,exclusion of palliative care and hospice care ,comprehensive care management services shall not include palliative care or hospice care4 7,i7 ,other services ,the ,secretary may require or permit other services1 as appropriate4 7#c7 ,eligible entity defined ,in this subsection1 the term eligible entity means an entity1 such as a health system1 hospital1 physician or nonphysician group practice1 multiple physician practices1 a ,federally qualified health center1 a rural health clinic1 or an accountable care organization1 that-- 7,a7 is qualified to furnish comprehensive care management services to an eligible individual1 and any unpaid caregiver of such eligible individual1 under the ,dementia ,care ,management ,model either directly or through arrangements with ,medicare participating providers of services and suppliers as well as social and community-based organizations2 7,b7 is accountable for the quality of comprehensive care management services furnished to an eligible individual under the model2 7,c7 furnishes comprehensive care management services through an interdisciplinary team that has at least #a physician1 physician assistant1 nurse practitioner1 or advanced practice nurse who devotes #be percent or more of patient contact time to the evaluation and care of patients with acquired cognitive impairment2 7,d7 furnishes comprehensive care management services in a culturally appropriate manner2 7,e7 utilizes a comprehensive1 person-centered care management approach2 7,f7 furnishes wellness and healthcare planning1 including medication review and management2 7,g7 supports family and caregiver engagement2 7,h7 provides access to a primary care provider or a member of the interdisciplinary team #bd hours a day #g days a week2 7,i7 has relationships with medical and nonmedical community-based organizations that support patients with ,alzheimer's disease or a related dementia and their caregivers2 and 7,j7 meets such other requirements as the ,secretary may determine to be appropriate4 7#d7 ,eligible individual defined ,in this subsection1 the term eligible individual means an individual-- 7,a7 who-- 7i7 is entitled to1 or enrolled for1 benefits under part ,a of title ,,xviii and enrolled under part ,b of such title 7including such an individual who is a dual eligible individual described in subsection 7a77#d77;,a77iii772 and 7ii7 is not enrolled under part ,c of such title or under a ,,pace program under section #ahid2 7,b7 who has been diagnosed with a form of dementia2 7,c7 who has not made an election to receive hospice care2 and 7,d7 who is not a resident of a nursing home4 7#e7 ,patient pathways 7,a7 ,initial placement 7i7 ,placement of patients into care pathways ,an eligible entity shall assign an eligible individual to an appropriate pathway 7as described in clauses 7ii71 7iii71 and 7iv77 based on an assessment of the clinical and financial status of the eligible individual that is conducted not later than #fj days after the eligible individual is enrolled in the model4 7ii7 ,pathway for uncomplicated dementia diagnosis ,during the preceding #ab-month period1 the eligible individual has not more than #a unplanned inpatient hospitalization or visit to a hospital emergency department4 7iii7 ,pathway for dementia diagnosis with enhanced care coordination needs ,during the preceding #ab-month period1 the eligible individual-- 7,i7 7aa7 has #b or more unplanned inpatient hospitalizations or visits to a hospital emergency department2 or 7bb7 has a psychiatric hospitalization2 and 7,,ii7 has sufficient financial or caregiver resources 7as determined by the ,secretary74 7iv7 ,pathway for dementia diagnosis with complex care needs ,during the preceding #ab-month period1 the eligible individual-- 7,i7 7aa7 has #b or more unplanned inpatient hospitalizations or visits to a hospital emergency department2 or 7bb7 has a psychiatric hospitalization2 and 7,,ii7 has insufficient financial or caregiver resources 7as determined by the ,secretary74 7,b7 ,regular patient assessments for appropriate pathway 7i7 ,in general ,after determination of the initial pathway1 at a frequency to be determined by the ,secretary1 but not less than once per year1 an eligible entity shall reassess the pathway determination of each eligible individual enrolled under the model4 7ii7 ,increased ,,adl limitations ,each eligible individual enrolled in the pathway for uncomplicated dementia diagnosis 7as described in subparagraph 7,a77ii77 who has had increased limitations in performing activities of daily living since the prior assessment shall be assigned to the pathway for dementia diagnosis with enhanced care coordination needs 7as described in subparagraph 7,a77iii77 or the pathway for dementia diagnosis with complex care needs 7as described in subparagraph 7,a77iv771 depending on the eligible individual's financial and caregiver resources applicable to each pathway4 7iii7 ,enhanced or complex care needs ,each eligible individual enrolled in the pathway for dementia diagnosis with enhanced care coordination needs 7as described in subparagraph 7,a77iii77 or the pathway for dementia diagnosis with complex care needs 7as described in subparagraph 7,a77iv77 shall be assigned to #a of the #b pathways based on the eligible individual's financial and caregiver resources applicable to each pathway4 7#f7 ,quality assessment 7,a7 ,in general ,the ,secretary shall specify appropriate measures to assess the quality of care furnished by an eligible entity under the ,dementia ,care ,management ,model4 ,such measures shall include1 as appropriate1 measures for clinical processes and outcomes1 patient and caregiver experience of care1 and utilization of services for which payment is made under the original medicare fee-for-service program under title ,,xviii1 including measures for-- 7i7 emergency department utilization2 7ii7 inpatient hospital utilization2 7iii7 documented advanced care plan2 7iv7 medication review2 7v7 screening for future fall risk2 7vi7 depression screening for caregivers2 7vii7 caregiver stress assessment2 and 7viii7 caregiver assessment of outcomes4 7,b7 ,reporting ,an eligible entity shall submit data in a form and manner determined by the ,secretary on measures specified by the ,secretary4 7,c7 ,performance assessment ,in order to assess the quality of care furnished by an eligible entity under the model1 the ,secretary shall establish-- 7i7 quality performance standards2 and 7ii7 methodologies for quality performance scoring and related payment adjustments4 7,d7 ,stakeholder input ,the ,secretary shall seek input from eligible entities on final measure specifications1 including appropriate adjustment for patient preferences4 7#g7 ,payments 7,a7 ,in general ,under the ,dementia ,care ,management ,model1 the ,secretary shall establish payment amounts for care management services furnished to eligible individuals1 including initial investment costs4 ,such amounts shall reflect start-up costs and initial investments incurred by an eligible entity in establishing the ,dementia ,care ,management ,model4 7,b7 ,capitated basis ,payments under the ,dementia ,care ,management ,model shall be made on a capitated basis1 such as a per-member1 per-month payment1 or such other similar payment mechanisms that the ,secretary determines to be appropriate4 ,payments shall vary based on the assigned pathway of each patient as described in paragraph 7#e74 7,c7 ,quality bonus ,under the ,dementia ,care ,management ,model1 additional payments shall be made to any eligible entity for quality bonuses based on the performance of the eligible entity in providing quality care 7as determined under paragraph 7#f774 7,d7 ,zero cost-sharing ,an eligible individual shall not be liable for any cost-sharing1 including deductibles1 coinsurance1 or copayments1 for care management services for dementia care furnished to such eligible individual under the model4 7,e7 ,supplemental to payments for covered services ,payments made under the model shall be in addition to any payments for items or services not provided under the model for which payment may be made under title ,,xviii for services furnished to such eligible individuals4 7,f7 ,nonduplication ,payments for care management services furnished to eligible individuals under the ,dementia ,care ,management ,model may not duplicate payments for services furnished to such eligible individuals for which payments are made under the original medicare fee-for-service program under title ,,xviii4 7#h7 ,waivers ,the ,secretary shall waive provisions of this title1 and title ,,xviii1 to permit an eligible entity operating a ,dementia ,care ,management ,model to provide the following3 7,a7 ,beneficiary rewards ,gift cards or other rewards for patients who successfully participate in the program 7as determined by the ,secretary74 7,b7 ,caregivers ,supports for caregivers4 7,c7 ,telehealth ,telehealth services without regard to geographic or other originating site limitations under section #ahcd7m74 7,d7 ,services from community organizations ,payments1 cost-sharing support1 or both1 for nonmedical services furnished by community-based organizations1 such as limited caregiving services1 respite care1 adult day care counseling services1 and such other services as the ,secretary determines to be appropriate4 7#i7 ,modifications for application in the ,primary ,care ,first and ,direct ,contracting ,models 7,a7 ,in general ,except as provided under subparagraph 7,b71 if the ,secretary elects to incorporate the ,dementia ,care ,management ,model into the ,primary ,care ,first ,model1 the ,direct ,contracting ,model1 or both1 as provided for under paragraph 7#a77;,c77i71 the ,secretary shall maintain the requirements of this subsection4 7,b7 ,permissible modifications ,the ,secretary may adjust the requirements of this subsection to the extent necessary to ensure consistency of the ,dementia ,care ,management ,model with the ,primary ,care ,first ,model1 the ,direct ,contracting ,model1 or both1 with respect to-- 7i7 any eligible entity1 including beneficiary alignment thresholds2 7ii7 any eligible individual2 7iii7 capitated payments2 and 7iv7 quality-bonus payments4 7,c7 ,consultation with stakeholders ,prior to making any adjustment under subparagraph 7,b71 the ,secretary shall consult with appropriate stakeholders and patient advocacy organizations4 7#aj7 ,outreach to underrepresented minority populations ,an eligible entity shall carry out public outreach and education efforts1 including the dissemination of information1 for members of underrepresented minority populations regarding participation in the ,dementia ,care ,management ,model to ensure diversity in the patient population of such model4 7#aa7 ,option to expand to ,medicaid ,the ,secretary may design a model under which payments are made under title ,,xix1 in a similar manner to the manner in which payments are made under title ,,xviii under the ,dementia ,care ,management ,model described in this subsection1 to eligible entities that furnish comprehensive care management services to individuals who are eligible for medical assistance under a ,state plan under title ,,xix 7or a waiver of such a plan7 with ,alzheimer's disease or a related dementia1 in order to test the effectiveness of comprehensive care management services on patient health1 care quality1 and care experience1 as well as on unpaid caregivers1 and on reducing spending under title ,,xix without reducing the quality of care4 4