Building Our Largest Dementia Infrastructure for Alzheimer's Act or the BOLD Infrastructure for Alzheimer's Act
This bill requires the Department of Health and Human Services to award cooperative agreements to state and local health departments to expand activities related to Alzheimer's disease, including activities involving early detection, support for caregivers, and public awareness.
[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4256 Introduced in House (IH)]
<DOC>
115th CONGRESS
1st Session
H. R. 4256
To amend the Public Health Service Act to authorize the expansion of
activities related to Alzheimer's disease, cognitive decline, and brain
health under the Alzheimer's Disease and Healthy Aging Program, and for
other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
November 6, 2017
Mr. Guthrie (for himself, Mr. Tonko, Ms. Maxine Waters of California,
and Mr. Smith of New Jersey) introduced the following bill; which was
referred to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to authorize the expansion of
activities related to Alzheimer's disease, cognitive decline, and brain
health under the Alzheimer's Disease and Healthy Aging Program, and for
other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Building Our Largest Dementia
Infrastructure for Alzheimer's Act'' or the ``BOLD Infrastructure for
Alzheimer's Act''.
SEC. 2. FINDINGS.
Congress finds as follows:
(1) According to former Surgeon General and Director of the
Centers for Disease Control and Prevention, Dr. David Satcher,
``Alzheimer's is the most under-recognized threat to public
health in the 21st century.''.
(2) Deaths from Alzheimer's disease increased 55 percent
between 1999 and 2014 in the United States, according to data
from the Centers for Disease Control and Prevention.
(3) More than 5,000,000 people in the United States are
living with Alzheimer's disease and, without significant
efforts to change the current trajectory, as many as 16,000,000
people in the United States will have Alzheimer's disease by
2050. This explosive growth will cause costs associated with
Alzheimer's disease to increase from an estimated
$259,000,000,000 in 2017 to more than $1,100,000,000,000 in
2050 (in 2017 dollars).
(4) Among individuals living with Alzheimer's disease and
other dementias, evidence indicates as many as 50 percent have
not been diagnosed. Among individuals diagnosed with
Alzheimer's disease, only 33 percent are aware of the
diagnosis. Early detection and diagnosis of Alzheimer's disease
and other dementias allow people to access available
treatments, build a care team, participate in support services,
and enroll in clinical trials. Early detection can help
physicians better manage a patient's comorbid conditions and
avoid prescribing medications that may worsen cognition or
function.
(5) Among individuals living with Alzheimer's disease and
other dementias, 25.3 percent experience a preventable
hospitalization, and such preventable hospitalizations cost the
Medicare program nearly $2,600,000,000 in 2013.
(6) African Americans are about 2 times more likely than
White Americans to have Alzheimer's disease and other
dementias. Hispanics are about one and one-half times more
likely than White Americans to have Alzheimer's disease and
other dementias.
(7) In 2016, 15,900,000 family members and friends provided
18,200,000,000 hours of unpaid care to individuals with
Alzheimer's disease and other dementias, at an economic value
of over $230,000,000,000. The physical and emotional impact of
caregiving of individuals with Alzheimer's disease and other
dementia resulted in an estimated $10,900,000,000 in increased
caregiver health costs in 2016.
(8) Strategy 4.B of the ``National Plan to Address
Alzheimer's Disease: 2017 Update'' of the Office of the
Assistant Secretary for Planning and Evaluation of the
Department of Health and Human Services is to ``work with
State, Tribal, and local governments to improve coordination
and identify model initiatives to advance Alzheimer's disease
awareness and readiness across the Government.''.
SEC. 3. PROMOTION OF PUBLIC HEALTH KNOWLEDGE AND AWARENESS OF
ALZHEIMER'S DISEASE, COGNITIVE DECLINE, AND BRAIN HEALTH
UNDER THE ALZHEIMER'S DISEASE AND HEALTHY AGING PROGRAM.
Part P of title III of the Public Health Service Act (42 U.S.C.
280g et seq.) is amended by adding at the end the following:
``SEC. 399V-7. PROMOTION OF PUBLIC HEALTH KNOWLEDGE AND AWARENESS OF
ALZHEIMER'S DISEASE, COGNITIVE DECLINE, AND BRAIN HEALTH
UNDER THE ALZHEIMER'S DISEASE AND HEALTHY AGING PROGRAM.
``(a) Definitions.--In the section:
``(1) Alzheimer's disease.--The term `Alzheimer's disease'
means Alzheimer's disease and related dementias.
``(2) Indian tribe; tribal organization.--The terms `Indian
tribe' and `tribal organization' have the meanings given such
terms in section 4 of the Indian Health Care Improvement Act.
``(b) Expansion of Activities Under the Alzheimer's Disease and
Healthy Aging Program.--In addition to activities conducted by the
Secretary under the Alzheimer's Disease and Healthy Aging Program of
the Centers for Disease Control and Prevention, the Secretary, acting
through the Director of the Centers for Disease Control and Prevention,
subject to appropriations under subsection (g), shall award cooperative
agreements under subsections (c), (d), and (e).
``(c) Centers of Excellence in Public Health Practice.--
``(1) In general.--The Secretary shall award cooperative
agreements to eligible entities for the establishment or
support of national or regional centers of excellence in public
health practice in Alzheimer's disease to--
``(A) advance the education of public health
officials of States, of political subdivisions of
States, and of Indian tribes or tribal organizations,
health care professionals, and the public on
Alzheimer's disease, cognitive decline, brain health,
and associated health disparities;
``(B) advance the efforts of public health
officials referred to in subparagraph (A) in applying
evidence-based systems change, communications, and
programmatic interventions for populations with
cognitive impairment, including Alzheimer's disease,
and caregivers for such populations; and
``(C) expand public-private partnerships engaged in
activities related to cognitive impairment and
associated health disparities with demonstrated success
or innovative programs (as determined by the
Secretary).
``(2) Requirements.--To be eligible to receive a
cooperative agreement under this subsection, an entity shall
submit to the Secretary an application containing such
agreements and information as the Secretary may require,
including an agreement that the center to be established or
supported under the cooperative agreement will operate in
accordance with the following:
``(A) The center will examine, evaluate, increase,
and promote evidence-based and effective Alzheimer's
disease and caregiving-related interventions for health
and social services professionals, underserved
populations, families, and the public, after
consultation with relevant State and local public
health officials, private-sector Alzheimer's disease
researchers, and advocates for individuals with
Alzheimer's disease.
``(B) The center will prioritize its activities on
the following:
``(i) Expanding efforts to educate State,
local, and tribal officials and public health
professionals in applying established data and
evidence-based best practices to address
Alzheimer's disease.
``(ii) Supporting public health officials
of States, of political subdivisions of States,
and of Indian tribes or tribal organizations in
implementing the most current version of the
`Healthy Brain Initiative: Public Health Road
Map' of the Centers for Disease Control and
Prevention.
``(iii) Supporting early detection and
diagnosis of Alzheimer's disease.
``(iv) Reducing the risk of potentially
avoidable hospitalizations of individuals with
Alzheimer's disease.
``(v) Reducing the risk of cognitive
decline and cognitive impairment, including
Alzheimer's disease.
``(vi) Enhancing support to meet the needs
of caregivers of individuals with Alzheimer's
disease.
``(vii) Reducing health disparities related
to the care and support of individuals with
cognitive decline and Alzheimer's disease.
``(viii) Supporting care planning and
management for individuals with Alzheimer's
disease.
``(3) Considerations.--In awarding cooperative agreements
under this subsection, the Secretary shall consider, among
other factors, whether the entity--
``(A) has access to rural areas or other
underserved populations;
``(B) is located in an area where the aggregate
success rate for applications for National Institutes
of Health funding has been historically low;
``(C) is able to build on an existing
infrastructure of service and public health research;
``(D) has experience with providing care, caregiver
support, and research related to Alzheimer's disease;
and
``(E) is integrated into existing local government
and public health infrastructures.
``(4) Distribution of awards.--In awarding cooperative
agreements under this subsection, the Secretary, to the extent
practicable, shall ensure equitable distribution of awards
based on geographic area, including consideration of rural
areas, and the burden of the disease on sub-populations.
``(d) Cooperative Agreements to Public Health Departments.--
``(1) In general.--The Secretary shall award cooperative
agreements to health departments of States, of political
subdivisions of States, and of Indian tribes and tribal
organizations to promote cognitive functioning, address
cognitive impairment for individuals living in such
communities, help meet the needs of caregivers, and address
unique aspects of Alzheimer's disease, as follows:
``(A) The Secretary shall award core capacity
cooperative agreements to such health departments to
support the development and implementation of systems
change, communications, and programmatic interventions
with respect to Alzheimer's disease, including
activities involving--
``(i) educating and informing the public
based on established public health research and
data;
``(ii) supporting early detection and
diagnosis;
``(iii) reducing the risk of potentially
avoidable hospitalizations;
``(iv) reducing the risk of cognitive
decline and cognitive impairment;
``(v) enhancing support to meet the needs
of caregivers;
``(vi) supporting care planning and
management; or
``(vii) supporting the actions set forth in
the most current version of the `Healthy Brain
Initiative: Public Health Road Map' of the
Centers for Disease Control and Prevention.
``(B) The Secretary shall award not less than 5
enhanced activity cooperative agreements to such health
departments to carry out activities related to
Alzheimer's disease, including through public-private
partnerships with organizations or other agencies, such
as large employers, public housing agencies, large
health care systems, and parks and recreation
departments, that include--
``(i) expanding implementation of programs
described in paragraph (2)(A) to reach larger
segments of the population; and
``(ii) implementing the reports described
in subparagraph (A)(vii).
``(2) Other considerations.--
``(A) Preference.--In awarding cooperative
agreements under paragraph (1), the Secretary shall
give preference to applications that focus on
addressing health disparities, including populations
and geographic areas that are most in need of
intervention.
``(B) Clarification on enhanced activity
cooperative agreements.--If the Secretary is unable to
identify 5 eligible health departments to receive a
cooperative agreement under paragraph (1)(B), the
Secretary shall allocate any amounts reserved for such
agreements to additional cooperative agreements under
paragraph (1)(A).
``(3) Eligibility.--To be eligible to receive a cooperative
agreement under paragraph (1), a State, political subdivision
of a State, Indian tribe, or tribal organization shall prepare
and submit to the Secretary an application at such time, in
such manner, and containing such information as the Secretary
may require, including a plan that describes--
``(A) how the applicant proposes to develop or
expand, programs to educate individuals through
partnership engagement, workforce development, guidance
and support for programmatic efforts, strategic
communication, and evaluation with respect to
Alzheimer's disease, and in the case of a cooperative
agreement under paragraph (1)(B), how the applicant
proposes to implement the most current version of the
`Healthy Brain Initiative: Public Health Road Map' of
the Centers for Disease Control and Prevention;
``(B) the manner in which the applicant will
coordinate with appropriate State and local authorities
as well as, in the case of a cooperative agreement
under paragraph (1)(B), relevant public and private
organizations or agencies; and
``(C) the manner in which the applicant will
evaluate the effectiveness of any program carried out
under the cooperative agreement.
``(4) Use of funds.--A health department awarded a
cooperative agreement under paragraph (1) shall use amounts
received under such cooperative agreement to--
``(A) develop, implement, disseminate, evaluate,
and if applicable, expand programs to educate
individuals on matters related to Alzheimer's disease
described in paragraph (1)(A); and
``(B) in the case of a cooperative agreement under
paragraph (1)(B), implement the most current version of
the `Healthy Brain Initiative: Public Health Road Map'
of the Centers for Disease Control and Prevention and
evaluate its implementation.
``(5) Matching requirement.--
``(A) In general.--Except as may be provided in
subparagraph (B), each health department that is
awarded a cooperative agreement under paragraph (1)
shall provide, from non-Federal sources, an amount
equal to 15 percent of the amount provided under such
agreement (which may be provided in cash or in-kind) to
carry out the activities supported by the cooperative
agreement.
``(B) Waiver authority.--The Secretary may waive
all or part of the matching requirement described in
subparagraph (A) for any fiscal year for--
``(i) a health department, if the Secretary
determines that applying such matching
requirement to the health department would
result in serious hardship or an inability to
carry out the purposes of the cooperative
agreement awarded to such health department; or
``(ii) a rural or frontier region.
``(e) Cooperative Agreements for Analysis and Reporting of Data
Regarding Cognitive Decline and Caregiving.--
``(1) In general.--The Secretary may award cooperative
agreements to eligible entities for the following activities:
``(A) The analysis and timely public reporting of
data on the State and national levels regarding
cognitive decline, including Alzheimer's disease,
caregiving, and health disparities experienced by
individuals with cognitive decline and their
caregivers.
``(B) The monitoring of objectives on dementia,
including Alzheimer's disease, and caregiving in the
program of the Secretary regarding health-status goals
for 2020 (commonly referred to as the `Healthy People
2020 report'), and the development and monitoring of
such objectives in future Healthy People reports of the
Department of Health and Human Services.
``(2) Eligibility.--To be eligible to receive a cooperative
agreement under this subsection, an entity shall be a public or
nonprofit private entity, including institutions of higher
education, and submit to the Secretary an application at such
time, in such manner, and containing such information as the
Secretary may require.
``(3) Surveillance.--The analysis, timely public reporting,
and dissemination of data regarding cognitive decline,
cognitive impairment, caregiving, and health disparities on the
State and national levels under a cooperative agreement under
this subsection may be carried out by eligible entities using
data sources such as the following:
``(A) The Behavioral Risk Factor Surveillance
System.
``(B) The National Health and Nutrition Examination
Survey.
``(C) The National Health Interview Survey.
``(f) Data Collection.--The Secretary shall collect data on
cognitive decline, cognitive impairment, caregiving, and health
disparities on the State and national levels, using the surveillance
systems described in subparagraphs (A) through (C) of subsection
(e)(3).
``(g) Nonduplication of Effort.--The Secretary shall ensure that
activities under any cooperative agreement awarded under this section
do not unnecessarily duplicate efforts of other agencies and offices
within the Department of Health and Human Services related to--
``(1) activities of centers of excellence in public health
practice with respect to Alzheimer's disease described in
subsection (c);
``(2) activities of public health departments with respect
to Alzheimer's disease described in subsection (d); or
``(3) the analysis and public reporting of surveillance
data on cognitive decline, caregiving, and health disparities
of individuals with Alzheimer's disease under subsection (e).
``(h) Authorization of Appropriations.--For each of fiscal years
2018 through 2025, there are authorized to be appropriated $12,000,000
for purposes of carrying out subsection (c), $20,000,000 for purposes
of carrying out subsection (d), and $5,000,000 for purposes of carrying
out subsections (e) and (f). Funds appropriated under this subsection
shall remain available until expended.''.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
Llama 3.2 · runs locally in your browser
Ask anything about this bill. The AI reads the full text to answer.
Enter to send · Shift+Enter for new line