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SENATE AMENDED
PRIOR PRINTER'S NOS. 1279, 1743, 1830
PRINTER'S NO. 2714
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1082
Session of
2021
INTRODUCED BY LEWIS DELROSSO, HILL-EVANS, THOMAS, MOUL, FREEMAN,
RYAN, MILLARD, ZIMMERMAN, WHEELAND, DEASY, NEILSON, JOZWIAK,
GILLEN, SAMUELSON AND COX, APRIL 19, 2021
AS AMENDED ON THIRD CONSIDERATION, IN SENATE, FEBRUARY 7, 2022
AN ACT
Establishing an education program to assist in the early
detection and diagnosis of Alzheimer's disease or a related
disorder.
AMENDING THE ACT OF APRIL 9, 1929 (P.L.343, NO.176), ENTITLED
"AN ACT RELATING TO THE FINANCES OF THE STATE GOVERNMENT;
PROVIDING FOR CANCER CONTROL, PREVENTION AND RESEARCH, FOR
AMBULATORY SURGICAL CENTER DATA COLLECTION, FOR THE JOINT
UNDERWRITING ASSOCIATION, FOR ENTERTAINMENT BUSINESS
FINANCIAL MANAGEMENT FIRMS, FOR PRIVATE DAM FINANCIAL
ASSURANCE AND FOR REINSTATEMENT OF ITEM VETOES; PROVIDING FOR
THE SETTLEMENT, ASSESSMENT, COLLECTION, AND LIEN OF TAXES,
BONUS, AND ALL OTHER ACCOUNTS DUE THE COMMONWEALTH, THE
COLLECTION AND RECOVERY OF FEES AND OTHER MONEY OR PROPERTY
DUE OR BELONGING TO THE COMMONWEALTH, OR ANY AGENCY THEREOF,
INCLUDING ESCHEATED PROPERTY AND THE PROCEEDS OF ITS SALE,
THE CUSTODY AND DISBURSEMENT OR OTHER DISPOSITION OF FUNDS
AND SECURITIES BELONGING TO OR IN THE POSSESSION OF THE
COMMONWEALTH, AND THE SETTLEMENT OF CLAIMS AGAINST THE
COMMONWEALTH, THE RESETTLEMENT OF ACCOUNTS AND APPEALS TO THE
COURTS, REFUNDS OF MONEYS ERRONEOUSLY PAID TO THE
COMMONWEALTH, AUDITING THE ACCOUNTS OF THE COMMONWEALTH AND
ALL AGENCIES THEREOF, OF ALL PUBLIC OFFICERS COLLECTING
MONEYS PAYABLE TO THE COMMONWEALTH, OR ANY AGENCY THEREOF,
AND ALL RECEIPTS OF APPROPRIATIONS FROM THE COMMONWEALTH,
AUTHORIZING THE COMMONWEALTH TO ISSUE TAX ANTICIPATION NOTES
TO DEFRAY CURRENT EXPENSES, IMPLEMENTING THE PROVISIONS OF
SECTION 7(A) OF ARTICLE VIII OF THE CONSTITUTION OF
PENNSYLVANIA AUTHORIZING AND RESTRICTING THE INCURRING OF
CERTAIN DEBT AND IMPOSING PENALTIES; AFFECTING EVERY
DEPARTMENT, BOARD, COMMISSION, AND OFFICER OF THE STATE
GOVERNMENT, EVERY POLITICAL SUBDIVISION OF THE STATE, AND
CERTAIN OFFICERS OF SUCH SUBDIVISIONS, EVERY PERSON,
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ASSOCIATION, AND CORPORATION REQUIRED TO PAY, ASSESS, OR
COLLECT TAXES, OR TO MAKE RETURNS OR REPORTS UNDER THE LAWS
IMPOSING TAXES FOR STATE PURPOSES, OR TO PAY LICENSE FEES OR
OTHER MONEYS TO THE COMMONWEALTH, OR ANY AGENCY THEREOF,
EVERY STATE DEPOSITORY AND EVERY DEBTOR OR CREDITOR OF THE
COMMONWEALTH," IN ARPA HEALTH CARE WORKFORCE SUPPORTS,
FURTHER PROVIDING FOR DEFINITIONS; AND PROVIDING FOR EARLY
DETECTION AND DIAGNOSIS OF ALZHEIMER'S DISEASE OR A RELATED
DISORDER.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Early
Detection and Diagnosis of Alzheimer's Disease or a Related
Disorder Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Alzheimer's disease or a related disorder." An irreversible
and progressive neurological disorder diagnosed by a physician
that has all of the following characteristics:
(1) The disorder causes cognitive decline and memory
impairment, behavioral and psychiatric problems and loss of
the ability to care for oneself.
(2) The disorder is severe enough to interfere with work
or social activities and requires continuous care or
supervision.
"Certified registered nurse practitioner." A registered
nurse licensed in this Commonwealth who is certified by the
State Board of Nursing in a particular clinical specialty area.
"Clinical nurse specialist." A registered nurse licensed in
this Commonwealth who is certified by the State Board of Nursing
as a clinical nurse specialist.
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"Department." The Department of Health of the Commonwealth.
"Physician." A medical doctor or doctor of osteopathy.
"Physician assistant." An individual who is licensed as a
physician assistant by the State Board of Medicine.
"Primary care workforce." Physicians, physician assistants,
certified registered nurse practitioners and clinical nurse
specialists delivering health care services to adult patients
with the detection, diagnosis, treatment and care planning
referral for individuals with Alzheimer's disease or a related
disorder.
"Primary care workforce education resources." The resources
established in section 3.
"Toolkit." The Early Detection and Diagnosis of Alzheimer's
Disease or a Related Disorder toolkit established in section
4(a).
Section 3. Primary care workforce education resources.
The department, in consultation with the Department of Aging
and other public or private organizations with expertise in
cognitive decline, Alzheimer's disease or a related disorder,
shall establish education resources to assist the primary care
workforce with the detection, diagnosis, treatment and care
planning referral for individuals with Alzheimer's disease or a
related disorder. At a minimum, the primary care workforce
education resources shall include all of the following related
to Alzheimer's disease or a related disorder:
(1) The importance of and value of early detection and
timely diagnosis.
(2) Increasing understanding and awareness of early
signs and symptoms.
(3) Person-centered care delivery.
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(4) Cultural competency.
(5) Racial and ethnic disparities and inequities in
detecting, diagnosing and accessing treatment and services.
(6) Use of validated cognitive assessment tools to
detect cognitive decline as part of the annual Medicare
Wellness Visit or other annual physical examination.
(7) Sources of clinical practice guidelines and tools.
(8) Effective care planning, including treatment
options, support and services, long-term care options,
financial planning, advanced directives and care
coordination, at all stages of dementia, including
appropriate counseling and referral.
Section 4. Early Detection and Diagnosis of Alzheimer's Disease
or a Related Disorder toolkit.
(a) Establishment.--The department shall establish and
maintain an Early Detection and Diagnosis of Alzheimer's Disease
or a Related Disorder toolkit. The toolkit, at a minimum, shall
provide all of the following:
(1) Best practices and cognitive assessment tools,
including the use of appropriate diagnostics, to assist the
primary care workforce in the detection, diagnosis, treatment
and care planning for individuals with Alzheimer's disease or
a related disorder.
(2) Primary care workforce education resources
established in section 3.
(b) Coordination and integration.--The department shall
coordinate and integrate the toolkit across health care sectors,
including, but not limited to, all of the following:
(1) Managed care programs administered through the
Department of Human Services.
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(2) Academic research institutions.
(3) State medical centers.
(4) Federally qualified health centers.
(5) Associations representing hospitals and health
systems.
(6) Organizations representing physicians and medical
students in Pennsylvania.
(7) Organizations representing the advancement of health
care and family physicians.
(8) Organizations representing the advancement of nurse
practitioners, health care professionals and health care
organizations.
(9) Organizations representing underserved communities
which may be disproportionately impacted by Alzheimer's
disease.
(10) Any other public or private organization, entity or
part of an organization or entity the department deems
necessary.
(c) Annual review.--The department shall review and update
the information on the toolkit established in subsection (a) to
reflect the most current and accurate information available on
an annual basis.
Section 5. Public awareness.
(a) Public information.--The department shall include and
make accessible on the department's publicly accessible Internet
website information relating to Alzheimer's disease or a related
disorder information. The information, at a minimum, shall
include the following:
(1) Understanding cognitive decline, Alzheimer's disease
or a related disorder, including the difference between
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normal cognitive aging and dementias.
(2) Early warning signs of Alzheimer's disease or a
related disorder.
(3) The benefits of early detection and diagnosis.
(4) Importance of discussing cognition with health care
providers and tips on how to do so.
(5) Risk reduction behaviors to slow onset of cognitive
impairment, particularly among diverse communities who are at
greater risk of developing Alzheimer's disease.
(b) Existing outreach programs.--The department shall
incorporate public information in subsection (a) into existing
relevant public health outreach programs administered by the
department to promote understanding and awareness of Alzheimer's
disease or a related disorder to the general public. Public
awareness information shall provide uniform, consistent guidance
in nonclinical terms, with an emphasis on cultural relevancy and
health literacy.
Section 6. Effective date.
This act shall take effect in 60 days.
SECTION 1. THE DEFINITION OF "HIGH MEDICAL ASSISTANCE
HOSPITAL" IN SECTION 101-J OF THE ACT OF APRIL 9, 1929 (P.L.343,
NO.176), KNOWN AS THE FISCAL CODE, ADDED JANUARY 26, 2022 (P.L.
, NO.2), IS AMENDED TO READ:
SECTION 101-J. DEFINITIONS.
THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS ARTICLE
SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE
CONTEXT CLEARLY INDICATES OTHERWISE:
* * *
"HIGH MEDICAL ASSISTANCE HOSPITAL." AS DETERMINED UNDER THE
MEDICAL ASSISTANCE DEPENDENCY [PAYMENT] ADJUSTMENT PROVISIONS OF
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THE COMMONWEALTH'S APPROVED TITLE XIX STATE PLAN, BASED ON A
HOSPITAL'S APPROVED MEDICAL ASSISTANCE COST REPORT FOR FISCAL
YEAR 2018-2019.
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SECTION 2. THE ACT IS AMENDED BY ADDING AN ARTICLE TO READ:
ARTICLE II-E
EARLY DETECTION AND DIAGNOSIS OF ALZHEIMER'S DISEASE OR A
RELATED DISORDER
SECTION 201-E. SCOPE OF ARTICLE.
THIS ARTICLE RELATES TO THE EARLY DETECTION AND DIAGNOSIS OF
ALZHEIMER'S DISEASE OR A RELATED DISORDER.
SECTION 202-E. DEFINITIONS.
THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS ARTICLE
SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE
CONTEXT CLEARLY INDICATES OTHERWISE:
"ALZHEIMER'S DISEASE OR A RELATED DISORDER." AN IRREVERSIBLE
AND PROGRESSIVE NEUROLOGICAL DISORDER DIAGNOSED BY A PHYSICIAN
THAT HAS ALL OF THE FOLLOWING CHARACTERISTICS:
(1) THE DISORDER CAUSES COGNITIVE DECLINE AND MEMORY
IMPAIRMENT, BEHAVIORAL AND PSYCHIATRIC PROBLEMS AND LOSS OF
THE ABILITY TO CARE FOR ONESELF.
(2) THE DISORDER IS SEVERE ENOUGH TO INTERFERE WITH WORK
OR SOCIAL ACTIVITIES AND REQUIRES CONTINUOUS CARE OR
SUPERVISION.
"CERTIFIED REGISTERED NURSE PRACTITIONER." A REGISTERED
NURSE LICENSED IN THIS COMMONWEALTH WHO IS CERTIFIED BY THE
STATE BOARD OF NURSING IN A PARTICULAR CLINICAL SPECIALTY AREA.
"CLINICAL NURSE SPECIALIST." A REGISTERED NURSE LICENSED IN
THIS COMMONWEALTH WHO IS CERTIFIED BY THE STATE BOARD OF NURSING
AS A CLINICAL NURSE SPECIALIST.
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"DEPARTMENT." THE DEPARTMENT OF HEALTH OF THE COMMONWEALTH.
"PHYSICIAN." A MEDICAL DOCTOR OR DOCTOR OF OSTEOPATHY.
"PHYSICIAN ASSISTANT." AN INDIVIDUAL WHO IS LICENSED AS A
PHYSICIAN ASSISTANT BY THE STATE BOARD OF MEDICINE.
"PRIMARY CARE WORKFORCE." PHYSICIANS, PHYSICIAN ASSISTANTS,
CERTIFIED REGISTERED NURSE PRACTITIONERS AND CLINICAL NURSE
SPECIALISTS DELIVERING HEALTH CARE SERVICES TO ADULT PATIENTS
WITH THE DETECTION, DIAGNOSIS, TREATMENT AND CARE PLANNING
REFERRAL FOR INDIVIDUALS WITH ALZHEIMER'S DISEASE OR A RELATED
DISORDER.
"PRIMARY CARE WORKFORCE EDUCATION RESOURCES." THE RESOURCES
ESTABLISHED IN SECTION 203-E.
"TOOLKIT." THE EARLY DETECTION AND DIAGNOSIS OF ALZHEIMER'S
DISEASE OR A RELATED DISORDER TOOLKIT ESTABLISHED IN SECTION
204-E(A).
SECTION 203-E. PRIMARY CARE WORKFORCE EDUCATION RESOURCES.
THE DEPARTMENT, IN CONSULTATION WITH THE DEPARTMENT OF AGING
AND OTHER PUBLIC OR PRIVATE ORGANIZATIONS WITH EXPERTISE IN
COGNITIVE DECLINE, ALZHEIMER'S DISEASE OR A RELATED DISORDER,
SHALL ESTABLISH EDUCATION RESOURCES TO ASSIST THE PRIMARY CARE
WORKFORCE WITH THE DETECTION, DIAGNOSIS, TREATMENT AND CARE
PLANNING REFERRAL FOR INDIVIDUALS WITH ALZHEIMER'S DISEASE OR A
RELATED DISORDER. AT A MINIMUM, THE PRIMARY CARE WORKFORCE
EDUCATION RESOURCES SHALL INCLUDE ALL OF THE FOLLOWING RELATED
TO ALZHEIMER'S DISEASE OR A RELATED DISORDER:
(1) THE IMPORTANCE OF AND VALUE OF EARLY DETECTION AND
TIMELY DIAGNOSIS.
(2) INCREASING UNDERSTANDING AND AWARENESS OF EARLY
SIGNS AND SYMPTOMS.
(3) PERSON-CENTERED CARE DELIVERY.
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(4) CULTURAL COMPETENCY.
(5) RACIAL AND ETHNIC DISPARITIES AND INEQUITIES IN
DETECTING, DIAGNOSING AND ACCESSING TREATMENT AND SERVICES.
(6) USE OF VALIDATED COGNITIVE ASSESSMENT TOOLS TO
DETECT COGNITIVE DECLINE AS PART OF THE ANNUAL MEDICARE
WELLNESS VISIT OR OTHER ANNUAL PHYSICAL EXAMINATION.
(7) SOURCES OF CLINICAL PRACTICE GUIDELINES AND TOOLS.
(8) EFFECTIVE CARE PLANNING, INCLUDING TREATMENT
OPTIONS, SUPPORT AND SERVICES, LONG-TERM CARE OPTIONS,
FINANCIAL PLANNING, ADVANCED DIRECTIVES AND CARE
COORDINATION, AT ALL STAGES OF DEMENTIA, INCLUDING
APPROPRIATE COUNSELING AND REFERRAL.
SECTION 204-E. EARLY DETECTION AND DIAGNOSIS OF ALZHEIMER'S
DISEASE OR A RELATED DISORDER TOOLKIT.
(A) ESTABLISHMENT.--THE DEPARTMENT SHALL ESTABLISH AND
MAINTAIN AN EARLY DETECTION AND DIAGNOSIS OF ALZHEIMER'S DISEASE
OR A RELATED DISORDER TOOLKIT. THE TOOLKIT, AT A MINIMUM, SHALL
PROVIDE ALL OF THE FOLLOWING:
(1) BEST PRACTICES AND COGNITIVE ASSESSMENT TOOLS,
INCLUDING THE USE OF APPROPRIATE DIAGNOSTICS, TO ASSIST THE
PRIMARY CARE WORKFORCE IN THE DETECTION, DIAGNOSIS, TREATMENT
AND CARE PLANNING FOR INDIVIDUALS WITH ALZHEIMER'S DISEASE OR
A RELATED DISORDER.
(2) PRIMARY CARE WORKFORCE EDUCATION RESOURCES
ESTABLISHED IN SECTION 203-E.
(B) COORDINATION AND INTEGRATION.--THE DEPARTMENT SHALL
COORDINATE AND INTEGRATE THE TOOLKIT ACROSS HEALTH CARE SECTORS,
INCLUDING, BUT NOT LIMITED TO, ALL OF THE FOLLOWING:
(1) MANAGED CARE PROGRAMS ADMINISTERED THROUGH THE
DEPARTMENT OF HUMAN SERVICES.
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(2) ACADEMIC RESEARCH INSTITUTIONS.
(3) STATE MEDICAL CENTERS.
(4) FEDERALLY QUALIFIED HEALTH CENTERS.
(5) ASSOCIATIONS REPRESENTING HOSPITALS AND HEALTH
SYSTEMS.
(6) ORGANIZATIONS REPRESENTING PHYSICIANS AND MEDICAL
STUDENTS IN PENNSYLVANIA.
(7) ORGANIZATIONS REPRESENTING THE ADVANCEMENT OF HEALTH
CARE AND FAMILY PHYSICIANS.
(8) ORGANIZATIONS REPRESENTING THE ADVANCEMENT OF NURSE
PRACTITIONERS, HEALTH CARE PROFESSIONALS AND HEALTH CARE
ORGANIZATIONS.
(9) ORGANIZATIONS REPRESENTING UNDERSERVED COMMUNITIES
WHICH MAY BE DISPROPORTIONATELY IMPACTED BY ALZHEIMER'S
DISEASE.
(10) ANY OTHER PUBLIC OR PRIVATE ORGANIZATION, ENTITY OR
PART OF AN ORGANIZATION OR ENTITY THE DEPARTMENT DEEMS
NECESSARY.
(C) ANNUAL REVIEW.--THE DEPARTMENT SHALL REVIEW AND UPDATE
THE INFORMATION ON THE TOOLKIT ESTABLISHED IN SUBSECTION (A) TO
REFLECT THE MOST CURRENT AND ACCURATE INFORMATION AVAILABLE ON
AN ANNUAL BASIS.
SECTION 205-E. PUBLIC AWARENESS.
(A) PUBLIC INFORMATION.--THE DEPARTMENT SHALL INCLUDE AND
MAKE ACCESSIBLE ON THE DEPARTMENT'S PUBLICLY ACCESSIBLE INTERNET
WEBSITE INFORMATION RELATING TO ALZHEIMER'S DISEASE OR A RELATED
DISORDER INFORMATION. THE INFORMATION, AT A MINIMUM, SHALL
INCLUDE THE FOLLOWING:
(1) UNDERSTANDING COGNITIVE DECLINE, ALZHEIMER'S DISEASE
OR A RELATED DISORDER, INCLUDING THE DIFFERENCE BETWEEN
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NORMAL COGNITIVE AGING AND DEMENTIAS.
(2) EARLY WARNING SIGNS OF ALZHEIMER'S DISEASE OR A
RELATED DISORDER.
(3) THE BENEFITS OF EARLY DETECTION AND DIAGNOSIS.
(4) IMPORTANCE OF DISCUSSING COGNITION WITH HEALTH CARE
PROVIDERS AND TIPS ON HOW TO DO SO.
(5) RISK REDUCTION BEHAVIORS TO SLOW ONSET OF COGNITIVE
IMPAIRMENT, PARTICULARLY AMONG DIVERSE COMMUNITIES WHO ARE AT
GREATER RISK OF DEVELOPING ALZHEIMER'S DISEASE.
(B) EXISTING OUTREACH PROGRAMS.--THE DEPARTMENT SHALL
INCORPORATE PUBLIC INFORMATION IN SUBSECTION (A) INTO EXISTING
RELEVANT PUBLIC HEALTH OUTREACH PROGRAMS ADMINISTERED BY THE
DEPARTMENT TO PROMOTE UNDERSTANDING AND AWARENESS OF ALZHEIMER'S
DISEASE OR A RELATED DISORDER TO THE GENERAL PUBLIC. PUBLIC
AWARENESS INFORMATION SHALL PROVIDE UNIFORM, CONSISTENT GUIDANCE
IN NONCLINICAL TERMS, WITH AN EMPHASIS ON CULTURAL RELEVANCY AND
HEALTH LITERACY.
SECTION 3. THIS ACT SHALL TAKE EFFECT IN 60 DAYS.
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