Comprehensive Care for Alzheimer’s Act

I 117TH CONGRESS 1ST SESSION H. R. 2517 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 HOUSE OF REPRESENTATIVES APRIL 14, 2021 Mr. HIGGINS of New York (for himself, Mr. LAHOOD, Mr. TONKO, and Mr. GUTHRIE) introduced the following bill; which was referred to the Com- mittee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 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 VerDate Sep 11 2014 02:39 Jun 04, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2517.IH H2517 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 2517 IH (1) in subsection (b)(2)(B), by adding at the 1 end the following new clause: 2 ‘‘(xxviii) Furnishing comprehensive 3 care management services to eligible indi- 4 viduals with Alzheimer’s disease or a re- 5 lated dementia through a Dementia Care 6 Management Model, as described in sub- 7 section (h).’’; and 8 (2) by adding at the end the following new sub- 9 section: 10 ‘‘(h) DEMENTIA CARE MANAGEMENT MODEL.— 11 ‘‘(1) DESCRIPTION OF MODEL AND REQUIRE- 12 MENTS.— 13 ‘‘(A) IN GENERAL.—The Dementia Care 14 Management Model described in this subsection 15 is a model under which payments are made 16 under title XVIII to eligible entities that fur- 17 nish comprehensive care management services 18 to eligible individuals with Alzheimer’s disease 19 or a related dementia, in order to test the effec- 20 tiveness of comprehensive care management 21 services on patient health, care quality, and 22 care experience, as well as on unpaid caregivers, 23 and on reducing spending under title XVIII 24 without reducing the quality of care. 25 VerDate Sep 11 2014 02:39 Jun 04, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2517.IH H2517 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 2517 IH ‘‘(B) VOLUNTARY PARTICIPATION.—Par- 1 ticipation under the Dementia Care Manage- 2 ment Model shall be voluntary with respect to 3 both eligible individuals and eligible entities. 4 ‘‘(C) IMPLEMENTATION OF DEMENTIA 5 CARE MANAGEMENT MODEL.— 6 ‘‘(i) IN GENERAL.—The Secretary 7 shall— 8 ‘‘(I) implement the Dementia 9 Care Management Model as a stand- 10 alone model; 11 ‘‘(II) incorporate the Dementia 12 Care Management Model into the Pri- 13 mary Care First Model; or 14 ‘‘(III) incorporate the Dementia 15 Care Management Model into— 16 ‘‘(aa) the Primary Care 17 First Model; and 18 ‘‘(bb) the Direct Contracting 19 Model. 20 ‘‘(ii) ADDITIONAL AUTHORITY.—In 21 addition to the models described in sub- 22 clauses (I) through (III) of clause (i), the 23 Secretary may incorporate the Dementia 24 Care Management Model into other exist- 25 VerDate Sep 11 2014 02:39 Jun 04, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2517.IH H2517 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 2517 IH ing coordinated care models established 1 under title XVIII or under this section, in- 2 cluding accountable care organizations, 3 value-based purchasing arrangements, and 4 such other coordinated care models as the 5 Secretary determines to be appropriate. 6 ‘‘(2) COMPREHENSIVE CARE MANAGEMENT 7 SERVICES DEFINED.—In this subsection, the term 8 ‘comprehensive care management services’ means 9 the following services furnished by an eligible entity 10 with respect to an eligible individual: 11 ‘‘(A) CONTINUOUS MONITORING AND AS- 12 SESSMENT.—An eligible entity shall regularly 13 assess and continuously monitor the following: 14 ‘‘(i) Neuropsychiatric symptoms, in- 15 cluding behavior, physical safety, and func- 16 tion of an eligible individual. 17 ‘‘(ii) Comorbidities. 18 ‘‘(iii) Financial resources and needs. 19 ‘‘(iv) Caregiver supports and re- 20 sources, including caregiver education, 21 training, and support. 22 ‘‘(v) The well-being of unpaid care- 23 givers of the eligible individual. 24 VerDate Sep 11 2014 02:39 Jun 04, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2517.IH H2517 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 2517 IH ‘‘(vi) Potential risks and harms of the 1 eligible individual’s home and environment 2 and the need for support for activities of 3 daily living. 4 ‘‘(B) ONGOING DEMENTIA CARE PLAN.— 5 An eligible entity shall develop and implement 6 an Alzheimer’s disease or related dementia care 7 plan, including advance care planning as appro- 8 priate, for an eligible individual. The care plan 9 shall include patient-centered goals for the eligi- 10 ble individual as well as goals for unpaid care- 11 givers of the eligible individual. Such care plan 12 shall be continuously evaluated and modified as 13 appropriate. 14 ‘‘(C) PSYCHOSOCIAL INTERVENTIONS.—An 15 eligible entity may implement psychosocial 16 interventions designed to prevent or reduce the 17 burden of cognitive, functional, behavioral, and 18 psychological challenges as well as the associ- 19 ated stress on unpaid caregivers of the eligible 20 individual. 21 ‘‘(D) SELF-MANAGEMENT TOOLS.—An eli- 22 gible entity shall provide self-management tools 23 to enhance the skills of the unpaid caregiver of 24 the eligible individual to manage the Alz- 25 VerDate Sep 11 2014 02:39 Jun 04, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2517.IH H2517 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 2517 IH heimer’s disease or related dementia of the eli- 1 gible individual and to navigate the health care 2 system. Such tools shall include training and 3 support for unpaid caregivers in managing the 4 limitations of eligible individuals, including edu- 5 cation, problem solving strategies, care naviga- 6 tion support, support after discharge from a 7 hospital or nursing home, and decision-making 8 support. 9 ‘‘(E) MEDICATION MANAGEMENT.—An eli- 10 gible entity shall furnish evidence-based medica- 11 tion review and management services to an eli- 12 gible individual, including polypharmacy man- 13 agement, using a planned process to reduce or 14 stop medications that may no longer be of ben- 15 efit or may be having adverse cognitive effects, 16 prescribing approved medications, and enhanc- 17 ing adherence to appropriate medications. 18 ‘‘(F) TREATMENT OF RELATED CONDI- 19 TIONS.—An eligible entity shall provide inter- 20 ventions to prevent or treat conditions related 21 to the Alzheimer’s disease or related dementia 22 of the eligible individual, such as depression 23 and delirium. 24 VerDate Sep 11 2014 02:39 Jun 04, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2517.IH H2517 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 2517 IH ‘‘(G) CARE COORDINATION.—An eligible 1 entity shall provide ongoing care management 2 services and shall coordinate services and sup- 3 ports among providers of services and suppliers, 4 as well as social and community resources. 5 Such services shall include necessary assistance 6 for referrals to social and community-based or- 7 ganizations, collaboration with primary care 8 providers and the interdisciplinary team of the 9 eligible individual, and support for care transi- 10 tions and continuity of care. 11 ‘‘(H) EXCLUSION OF PALLIATIVE CARE 12 AND HOSPICE CARE.—Comprehensive care man- 13 agement services shall not include palliative 14 care or hospice care. 15 ‘‘(I) OTHER SERVICES.—The Secretary 16 may require or permit other services, as appro- 17 priate. 18 ‘‘(3) ELIGIBLE ENTITY DEFINED.—In this sub- 19 section, the term ‘eligible entity’ means an entity, 20 such as a health system, hospital, physician or non- 21 physician group practice, multiple physician prac- 22 tices, a Federally qualified health center, a rural 23 health clinic, or an accountable care organization, 24 that— 25 VerDate Sep 11 2014 02:39 Jun 04, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2517.IH H2517 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 2517 IH ‘‘(A) is qualified to furnish comprehensive 1 care management services to an eligible indi- 2 vidual, and any unpaid caregiver of such eligible 3 individual, under the Dementia Care Manage- 4 ment Model either directly or through arrange- 5 ments with Medicare participating providers of 6 services and suppliers as well as social and com- 7 munity-based organizations; 8 ‘‘(B) is accountable for the quality of com- 9 prehensive care management services furnished 10 to an eligible individual under the model; 11 ‘‘(C) furnishes comprehensive care man- 12 agement services through an interdisciplinary 13 team that has at least 1 physician, physician 14 assistant, nurse practitioner, or advanced prac- 15 tice nurse who devotes 25 percent or more of 16 patient contact time to the evaluation and care 17 of patients with acquired cognitive impairment; 18 ‘‘(D) furnishes comprehensive care man- 19 agement services in a culturally appropriate 20 manner; 21 ‘‘(E) utilizes a comprehensive, person-cen- 22 tered care management approach; 23 VerDate Sep 11 2014 02:39 Jun 04, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2517.IH H2517 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 2517 IH ‘‘(F) furnishes wellness and healthcare 1 planning, including medication review and man- 2 agement; 3 ‘‘(G) supports family and caregiver engage- 4 ment; 5 ‘‘(H) provides access to a primary care 6 provider or a member of the interdisciplinary 7 team 24 hours a day 7 days a week; 8 ‘‘(I) has relationships with medical and 9 nonmedical community-based organizations that 10 support patients with Alzheimer’s disease or a 11 related dementia and their caregivers; and 12 ‘‘(J) meets such other requirements as the 13 Secretary may determine to be appropriate. 14 ‘‘(4) ELIGIBLE INDIVIDUAL DEFINED.—In this 15 subsection, the term ‘eligible individual’ means an 16 individual— 17 ‘‘(A) who— 18 ‘‘(i) is entitled to, or enrolled for, ben- 19 efits under part A of title XVIII and en- 20 rolled under part B of such title (including 21 such an individual who is a dual eligible in- 22 dividual described in subsection 23 (a)(4)(A)(iii)); and 24 VerDate Sep 11 2014 02:39 Jun 04, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2517.IH H2517 kjohnson on DSK79L0C42PROD with BILLS 10 •HR 2517 IH ‘‘(ii) is not enrolled under part C of 1 such title or under a PACE program under 2 section 1894; 3 ‘‘(B) who has been diagnosed with a form 4 of dementia; 5 ‘‘(C) who has not made an election to re- 6 ceive hospice care; and 7 ‘‘(D) who is not a resident of a nursing 8 home. 9 ‘‘(5) PATIENT PATHWAYS.— 10 ‘‘(A) INITIAL PLACEMENT.— 11 ‘‘(i) PLACEMENT OF PATIENTS INTO 12 CARE PATHWAYS.—An eligible entity shall 13 assign an eligible individual to an appro- 14 priate pathway (as described in clauses 15 (ii), (iii), and (iv)) based on an assessment 16 of the clinical and financial status of the 17 eligible individual that is conducted not 18 later than 60 days after the eligible indi- 19 vidual is enrolled in the model. 20 ‘‘(ii) PATHWAY FOR UNCOMPLICATED 21 DEMENTIA DIAGNOSIS.—During the pre- 22 ceding 12-month period, the eligible indi- 23 vidual has not more than 1 unplanned in- 24 VerDate Sep 11 2014 02:39 Jun 04, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2517.IH H2517 kjohnson on DSK79L0C42PROD with BILLS 11 •HR 2517 IH patient hospitalization or visit to a hospital 1 emergency department. 2 ‘‘(iii) PATHWAY FOR DEMENTIA DIAG- 3 NOSIS WITH ENHANCED CARE COORDINA- 4 TION NEEDS.—During the preceding 12- 5 month period, the eligible individual— 6 ‘‘(I)(aa) has 2 or more un- 7 planned inpatient hospitalizations or 8 visits to a hospital emergency depart- 9 ment; or 10 ‘‘(bb) has a psychiatric hos- 11 pitalization; and 12 ‘‘(II) has sufficient financial or 13 caregiver resources (as determined by 14 the Secretary). 15 ‘‘(iv) PATHWAY FOR DEMENTIA DIAG- 16 NOSIS WITH COMPLEX CARE NEEDS.—Dur- 17 ing the preceding 12-month period, the eli- 18 gible individual— 19 ‘‘(I)(aa) has 2 or more un- 20 planned inpatient hospitalizations or 21 visits to a hospital emergency depart- 22 ment; or 23 ‘‘(bb) has a psychiatric hos- 24 pitalization; and 25 VerDate Sep 11 2014 02:39 Jun 04, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H2517.IH H2517 kjohnson on DSK79L0C42PROD with BILLS 12 •HR 2517 IH ‘‘(II) has insufficient financial or 1 caregiver resources (as determined by 2 the Secretary). 3 ‘‘(B) REGULAR PATIENT ASSESSMENTS 4 FOR APPROPRIATE PATHWAY.— 5 ‘‘(i) IN GENERAL.—After determina- 6 tion of the initial pathway, at a frequency 7 to be determined by the Secretary, but not 8 less than once per year, an eligible entity 9 shall reassess the pathway determination 10 of each eligible individual enrolled under 11 the model. 12 ‘‘(ii) INCREASED ADL LIMITATIONS.— 13 Each eligible individual enrolled in the 14 pathway for uncomplicated dementia diag- 15 nosis (as described in subparagraph 16 (A)(ii)) who has had increased limitations 17 in performing activities of daily living since 18 the prior assessment shall be assigned to 19 the pathway for dementia diagnosis with 20 enhanced care coordination needs (as de- 21 scribed in subparagraph (A)(iii)) or the 22 pathway for dementia diagnosis with com- 23 plex care needs (as described in subpara- 24 graph (A)(iv)), depending on the eligible 25 VerDate Sep 11 2014 02:39 Jun 04, 2021 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H2517.IH H2517 kjohnson on DSK79L0C42PROD with BILLS 13 •HR 2517 IH individual’s financial and caregiver re- 1 sources applicable to each pathway. 2 ‘‘(iii) ENHANCED OR COMPLEX CARE 3 NEEDS.—Each eligible individual enrolled 4 in the pathway for dementia diagnosis with 5 enhanced care coordination needs (as de- 6 scribed in subparagraph (A)(iii)) or the 7 pathway for dementia diagnosis with com- 8 plex care needs (as described in subpara- 9 graph (A)(iv)) shall be assigned to 1 of the 10 2 pathways based on the eligible individ- 11 ual’s financial and caregiver resources ap- 12 plicable to each pathway. 13 ‘‘(6) QUALITY ASSESSMENT.— 14 ‘‘(A) IN GENERAL.—The Secretary shall 15 specify appropriate measures to assess the qual- 16 ity of care furnished by an eligible entity under 17 the Dem [Text truncated for display. 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