IN THE SENATE OF THE UNITED STATES
April 6 (legislative day, April 5), 2011
Ms. Stabenow (for herself and Ms. Collins) introduced the following bill; which was read twice and referred to the Committee on Finance
To amend title XVIII of the Social Security Act to provide for Medicare coverage of comprehensive Alzheimer's disease and related dementia diagnosis and services in order to improve care and outcomes for Americans living with Alzheimer's disease and related dementias by improving detection, diagnosis, and care planning.
This Act may be cited as the
Health Outcomes, Planning, and
Education for Alzheimer’s Act.
Medicare coverage of comprehensive Alzheimer’s disease diagnosis and services
Section 1861 of the Social Security Act is amended—
in subsection (s)(2)—
and at the end of subparagraph (EE);
and at the end of subparagraph (FF); and
by adding at the end the following new subparagraph:
comprehensive Alzheimer’s disease diagnosis and services (as defined in subsection (iii));
by adding at the end the following new subsection:
Comprehensive Alzheimer’s disease diagnosis and services
The term comprehensive Alzheimer’s disease diagnosis and services means the services described in paragraph (2) furnished to an individual—
who does not already have a diagnosis of Alzheimer’s disease; and
for whom a physician or a practitioner described in clause (i), (iv), or (v) of section 1842(b)(18)(C), in a medical setting such as a physician's office, a hospital, a skilled nursing facility, a community health center, or another similar medical setting—
has detected the individual may have a cognitive impairment or dementia; and
pursuant to such detection, has determined a diagnostic evaluation for Alzheimer’s disease is needed.
The services described in this paragraph are the following:
A diagnostic evaluation, including referral to a specialist if recommended.
If the individual is diagnosed with Alzheimer's disease under the diagnostic evaluation under subparagraph (A), care planning services (with the individual or with one or more family caregivers of the individual without the presence of the individual), including assistance understanding the diagnosis as well as the medical and non-medical options for ongoing treatment, services, and supports, and information about how to obtain such treatments, services, and supports.
Medical record documentation, with respect to an individual, of the diagnostic evaluation under subparagraph (A), the diagnosis, and any care planning services under subparagraph (B).
In this subsection, the term
Alzheimer's disease means Alzheimer's disease and related
Section 1833(a)(1) of the Social Security
Act (42 U.S.C. 1395l(a)(1)) is amended by striking
(Z) and inserting before the semicolon at the end the following:
, and (AA) with respect to comprehensive Alzheimer’s disease diagnosis
and services (as defined in section 1861(iii)), the amount paid shall be an
amount equal to 80 percent of the amount determined under a fee schedule
designated by the Secretary.
The amendments made by this section shall apply to services furnished on or after January 1 of the year following the year which includes the date of the enactment of this Act.