Comprehensive Care for Alzheimer’s Act

II 117TH CONGRESS 1ST SESSION S. 1125 To recommend that the Center for Medicare and Medicaid Innovation test the effect of a dementia care management model, and for other purposes. IN THE SENATE OF THE UNITED STATES APRIL 14, 2021 Ms. STABENOW (for herself and Mrs. CAPITO) introduced the following bill; 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 manage- ment model, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Comprehensive Care 4 for Alzheimer’s Act’’. 5 SEC. 2. CMI TESTING OF DEMENTIA CARE MANAGEMENT. 6 Section 1115A of the Social Security Act (42 U.S.C. 7 1315a) is amended— 8 (1) in subsection (b)(2)(B), by adding at the 9 end the following new clause: 10 VerDate Sep 11 2014 05:35 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1125.IS S1125 kjohnson on DSK79L0C42PROD with BILLS 2 •S 1125 IS ‘‘(xxviii) Furnishing comprehensive 1 care management services to eligible indi- 2 viduals with Alzheimer’s disease or a re- 3 lated dementia through a Dementia Care 4 Management Model, as described in sub- 5 section (h).’’; and 6 (2) by adding at the end the following new sub- 7 section: 8 ‘‘(h) DEMENTIA CARE MANAGEMENT MODEL.— 9 ‘‘(1) DESCRIPTION OF MODEL AND REQUIRE- 10 MENTS.— 11 ‘‘(A) IN GENERAL.—The Dementia Care 12 Management Model described in this subsection 13 is a model under which payments are made 14 under title XVIII to eligible entities that fur- 15 nish comprehensive care management services 16 to eligible individuals with Alzheimer’s disease 17 or a related dementia, in order to test the effec- 18 tiveness of comprehensive care management 19 services on patient health, care quality, and 20 care experience, as well as on unpaid caregivers, 21 and on reducing spending under title XVIII 22 without reducing the quality of care. 23 ‘‘(B) VOLUNTARY PARTICIPATION.—Par- 24 ticipation under the Dementia Care Manage- 25 VerDate Sep 11 2014 05:35 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1125.IS S1125 kjohnson on DSK79L0C42PROD with BILLS 3 •S 1125 IS ment Model shall be voluntary with respect to 1 both eligible individuals and eligible entities. 2 ‘‘(C) IMPLEMENTATION OF DEMENTIA 3 CARE MANAGEMENT MODEL.— 4 ‘‘(i) IN GENERAL.—The Secretary 5 shall— 6 ‘‘(I) implement the Dementia 7 Care Management Model as a stand- 8 alone model; 9 ‘‘(II) incorporate the Dementia 10 Care Management Model into the Pri- 11 mary Care First Model; or 12 ‘‘(III) incorporate the Dementia 13 Care Management Model into— 14 ‘‘(aa) the Primary Care 15 First Model; and 16 ‘‘(bb) the Direct Contracting 17 Model. 18 ‘‘(ii) ADDITIONAL AUTHORITY.—In 19 addition to the models described in sub- 20 clauses (I) through (III) of clause (i), the 21 Secretary may incorporate the Dementia 22 Care Management Model into other exist- 23 ing coordinated care models established 24 under title XVIII or under this section, in- 25 VerDate Sep 11 2014 05:35 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1125.IS S1125 kjohnson on DSK79L0C42PROD with BILLS 4 •S 1125 IS cluding accountable care organizations, 1 value-based purchasing arrangements, and 2 such other coordinated care models as the 3 Secretary determines to be appropriate. 4 ‘‘(2) COMPREHENSIVE CARE MANAGEMENT 5 SERVICES DEFINED.—In this subsection, the term 6 ‘comprehensive care management services’ means 7 the following services furnished by an eligible entity 8 with respect to an eligible individual: 9 ‘‘(A) CONTINUOUS MONITORING AND AS- 10 SESSMENT.—An eligible entity shall regularly 11 assess and continuously monitor the following: 12 ‘‘(i) Neuropsychiatric symptoms, in- 13 cluding behavior, physical safety, and func- 14 tion of an eligible individual. 15 ‘‘(ii) Comorbidities. 16 ‘‘(iii) Financial resources and needs. 17 ‘‘(iv) Caregiver supports and re- 18 sources, including caregiver education, 19 training, and support. 20 ‘‘(v) The well-being of unpaid care- 21 givers of the eligible individual. 22 ‘‘(vi) Potential risks and harms of the 23 eligible individual’s home and environment 24 VerDate Sep 11 2014 05:35 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1125.IS S1125 kjohnson on DSK79L0C42PROD with BILLS 5 •S 1125 IS and the need for support for activities of 1 daily living. 2 ‘‘(B) ONGOING DEMENTIA CARE PLAN.— 3 An eligible entity shall develop and implement 4 an Alzheimer’s disease or related dementia care 5 plan, including advance care planning as appro- 6 priate, for an eligible individual. The care plan 7 shall include patient-centered goals for the eligi- 8 ble individual as well as goals for unpaid care- 9 givers of the eligible individual. Such care plan 10 shall be continuously evaluated and modified as 11 appropriate. 12 ‘‘(C) PSYCHOSOCIAL INTERVENTIONS.—An 13 eligible entity may implement psychosocial 14 interventions designed to prevent or reduce the 15 burden of cognitive, functional, behavioral, and 16 psychological challenges as well as the associ- 17 ated stress on unpaid caregivers of the eligible 18 individual. 19 ‘‘(D) SELF-MANAGEMENT TOOLS.—An eli- 20 gible entity shall provide self-management tools 21 to enhance the skills of the unpaid caregiver of 22 the eligible individual to manage the Alz- 23 heimer’s disease or related dementia of the eli- 24 gible individual and to navigate the health care 25 VerDate Sep 11 2014 05:35 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1125.IS S1125 kjohnson on DSK79L0C42PROD with BILLS 6 •S 1125 IS system. Such tools shall include training and 1 support for unpaid caregivers in managing the 2 limitations of eligible individuals, including edu- 3 cation, problem solving strategies, care naviga- 4 tion support, support after discharge from a 5 hospital or nursing home, and decision-making 6 support. 7 ‘‘(E) MEDICATION MANAGEMENT.—An eli- 8 gible entity shall furnish evidence-based medica- 9 tion review and management services to an eli- 10 gible individual, including polypharmacy man- 11 agement, using a planned process to reduce or 12 stop medications that may no longer be of ben- 13 efit or may be having adverse cognitive effects, 14 prescribing approved medications, and enhanc- 15 ing adherence to appropriate medications. 16 ‘‘(F) TREATMENT OF RELATED CONDI- 17 TIONS.—An eligible entity shall provide inter- 18 ventions to prevent or treat conditions related 19 to the Alzheimer’s disease or related dementia 20 of the eligible individual, such as depression 21 and delirium. 22 ‘‘(G) CARE COORDINATION.—An eligible 23 entity shall provide ongoing care management 24 services and shall coordinate services and sup- 25 VerDate Sep 11 2014 05:35 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1125.IS S1125 kjohnson on DSK79L0C42PROD with BILLS 7 •S 1125 IS ports among providers of services and suppliers, 1 as well as social and community resources. 2 Such services shall include necessary assistance 3 for referrals to social and community-based or- 4 ganizations, collaboration with primary care 5 providers and the interdisciplinary team of the 6 eligible individual, and support for care transi- 7 tions and continuity of care. 8 ‘‘(H) EXCLUSION OF PALLIATIVE CARE 9 AND HOSPICE CARE.—Comprehensive care man- 10 agement services shall not include palliative 11 care or hospice care. 12 ‘‘(I) OTHER SERVICES.—The Secretary 13 may require or permit other services, as appro- 14 priate. 15 ‘‘(3) ELIGIBLE ENTITY DEFINED.—In this sub- 16 section, the term ‘eligible entity’ means an entity, 17 such as a health system, hospital, physician or non- 18 physician group practice, multiple physician prac- 19 tices, a Federally qualified health center, a rural 20 health clinic, or an accountable care organization, 21 that— 22 ‘‘(A) is qualified to furnish comprehensive 23 care management services to an eligible indi- 24 vidual, and any unpaid caregiver of such eligible 25 VerDate Sep 11 2014 05:35 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1125.IS S1125 kjohnson on DSK79L0C42PROD with BILLS 8 •S 1125 IS individual, under the Dementia Care Manage- 1 ment Model either directly or through arrange- 2 ments with Medicare participating providers of 3 services and suppliers as well as social and com- 4 munity-based organizations; 5 ‘‘(B) is accountable for the quality of com- 6 prehensive care management services furnished 7 to an eligible individual under the model; 8 ‘‘(C) furnishes comprehensive care man- 9 agement services through an interdisciplinary 10 team that has at least 1 physician, physician 11 assistant, nurse practitioner, or advanced prac- 12 tice nurse who devotes 25 percent or more of 13 patient contact time to the evaluation and care 14 of patients with acquired cognitive impairment; 15 ‘‘(D) furnishes comprehensive care man- 16 agement services in a culturally appropriate 17 manner; 18 ‘‘(E) utilizes a comprehensive, person-cen- 19 tered care management approach; 20 ‘‘(F) furnishes wellness and healthcare 21 planning, including medication review and man- 22 agement; 23 ‘‘(G) supports family and caregiver engage- 24 ment; 25 VerDate Sep 11 2014 05:35 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1125.IS S1125 kjohnson on DSK79L0C42PROD with BILLS 9 •S 1125 IS ‘‘(H) provides access to a primary care 1 provider or a member of the interdisciplinary 2 team 24 hours a day 7 days a week; 3 ‘‘(I) has relationships with medical and 4 nonmedical community-based organizations that 5 support patients with Alzheimer’s disease or a 6 related dementia and their caregivers; and 7 ‘‘(J) meets such other requirements as the 8 Secretary may determine to be appropriate. 9 ‘‘(4) ELIGIBLE INDIVIDUAL DEFINED.—In this 10 subsection, the term ‘eligible individual’ means an 11 individual— 12 ‘‘(A) who— 13 ‘‘(i) is entitled to, or enrolled for, ben- 14 efits under part A of title XVIII and en- 15 rolled under part B of such title (including 16 such an individual who is a dual eligible in- 17 dividual described in subsection 18 (a)(4)(A)(iii)); and 19 ‘‘(ii) is not enrolled under part C of 20 such title or under a PACE program under 21 section 1894; 22 ‘‘(B) who has been diagnosed with a form 23 of dementia; 24 VerDate Sep 11 2014 05:35 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1125.IS S1125 kjohnson on DSK79L0C42PROD with BILLS 10 •S 1125 IS ‘‘(C) who has not made an election to re- 1 ceive hospice care; and 2 ‘‘(D) who is not a resident of a nursing 3 home. 4 ‘‘(5) PATIENT PATHWAYS.— 5 ‘‘(A) INITIAL PLACEMENT.— 6 ‘‘(i) PLACEMENT OF PATIENTS INTO 7 CARE PATHWAYS.—An eligible entity shall 8 assign an eligible individual to an appro- 9 priate pathway (as described in clauses 10 (ii), (iii), and (iv)) based on an assessment 11 of the clinical and financial status of the 12 eligible individual that is conducted not 13 later than 60 days after the eligible indi- 14 vidual is enrolled in the model. 15 ‘‘(ii) PATHWAY FOR UNCOMPLICATED 16 DEMENTIA DIAGNOSIS.—During the pre- 17 ceding 12-month period, the eligible indi- 18 vidual has not more than 1 unplanned in- 19 patient hospitalization or visit to a hospital 20 emergency department. 21 ‘‘(iii) PATHWAY FOR DEMENTIA DIAG- 22 NOSIS WITH ENHANCED CARE COORDINA- 23 TION NEEDS.—During the preceding 12- 24 month period, the eligible individual— 25 VerDate Sep 11 2014 05:35 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1125.IS S1125 kjohnson on DSK79L0C42PROD with BILLS 11 •S 1125 IS ‘‘(I)(aa) has 2 or more un- 1 planned inpatient hospitalizations or 2 visits to a hospital emergency depart- 3 ment; or 4 ‘‘(bb) has a psychiatric hos- 5 pitalization; and 6 ‘‘(II) has sufficient financial or 7 caregiver resources (as determined by 8 the Secretary). 9 ‘‘(iv) PATHWAY FOR DEMENTIA DIAG- 10 NOSIS WITH COMPLEX CARE NEEDS.—Dur- 11 ing the preceding 12-month period, the eli- 12 gible individual— 13 ‘‘(I)(aa) has 2 or more un- 14 planned inpatient hospitalizations or 15 visits to a hospital emergency depart- 16 ment; or 17 ‘‘(bb) has a psychiatric hos- 18 pitalization; and 19 ‘‘(II) has insufficient financial or 20 caregiver resources (as determined by 21 the Secretary). 22 ‘‘(B) REGULAR PATIENT ASSESSMENTS 23 FOR APPROPRIATE PATHWAY.— 24 VerDate Sep 11 2014 05:35 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1125.IS S1125 kjohnson on DSK79L0C42PROD with BILLS 12 •S 1125 IS ‘‘(i) IN GENERAL.—After determina- 1 tion of the initial pathway, at a frequency 2 to be determined by the Secretary, but not 3 less than once per year, an eligible entity 4 shall reassess the pathway determination 5 of each eligible individual enrolled under 6 the model. 7 ‘‘(ii) INCREASED ADL LIMITATIONS.— 8 Each eligible individual enrolled in the 9 pathway for uncomplicated dementia diag- 10 nosis (as described in subparagraph 11 (A)(ii)) who has had increased limitations 12 in performing activities of daily living since 13 the prior assessment shall be assigned to 14 the pathway for dementia diagnosis with 15 enhanced care coordination needs (as de- 16 scribed in subparagraph (A)(iii)) or the 17 pathway for dementia diagnosis with com- 18 plex care needs (as described in subpara- 19 graph (A)(iv)), depending on the eligible 20 individual’s financial and caregiver re- 21 sources applicable to each pathway. 22 ‘‘(iii) ENHANCED OR COMPLEX CARE 23 NEEDS.—Each eligible individual enrolled 24 in the pathway for dementia diagnosis with 25 VerDate Sep 11 2014 05:35 Apr 27, 2021 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S1125.IS S1125 kjohnson on DSK79L0C42PROD with BILLS 13 •S 1125 IS enhanced care coordination needs (as de- 1 scribed in subparagraph (A)(iii)) or the 2 pathway for dementia diagnosis with com- 3 plex care needs (as described in subpara- 4 graph (A)(iv)) shall be assigned to 1 of the 5 2 pathways based on the eligible individ- 6 ual’s financial and caregiver resources ap- 7 plicable to each pathway. 8 ‘‘(6) QUALITY ASSESSMENT.— 9 ‘‘(A) IN GENERAL.—The Secretary shall 10 specify appropriate measures to assess the qual- 11 ity of care furnished by an eligible entity under 12 the Dementia Care Management Model. Such 13 measures shall include, as appropriate, meas- 14 ures for clinical processes and outcomes, patient 15 and caregiver experience of care, and utilization 16 of services for which payment is made under 17 the original medicare fee- [Text truncated for display. Full text available on Congress.gov.]