SB 482: RELATING TO COGNITIVE ASSESSMENTS.

A BILL FOR AN ACT

relating to cognitive assessments.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

     SECTION 1.  The legislature finds that families caring for individuals with Alzheimer's disease and related dementias face many challenges when attempting to balance their professional lives with the provision of care to their loved ones.  Caregivers often must choose between continuing their careers or becoming full-time caregivers.  According to the Alzheimer's Association, Hawaii has approximately sixty thousand family caregivers providing ninety-one million hours of unpaid care valued at $1,900,000,000.

     The legislature further finds that 6.7 per cent of individuals aged forty-five or older experience subjective cognitive decline.  After age sixty-five, the risk of Alzheimer's doubles every five years, with individuals on medicare considered at higher risk of having or developing dementia.  According to the Centers for Disease Control and Prevention, by 2060, nearly fourteen million adults in the United States are projected to have Alzheimer's disease.  Nationwide, the costs to care for individuals living with Alzheimer's and related dementias is significant, with the total cost of care for Alzheimer's projected to increase to more than $1,100,000,000,000 by 2050.  However, a 2018 report from the Alzheimer's Association indicated that early diagnosis and treatment of dementia could save the nation as much as $7,900,000,000,000 in medical and care costs over thirty years.

     The treatment and prevention of Alzheimer's disease and related dementias is a pressing concern to the State.  Per the department of business, economic development, and tourism, nearly one in five residents in Hawaii is sixty-five years of age or older, with this age group rapidly expanding in size.  Annually, Alzheimer's and related dementias cost the State's medicaid program $285,000,000.  In the Hawaii 2025: State Plan on Alzheimer's Disease and Related Dementias: 2020 Update, the executive office on aging found that medicare costs for the Alzheimer's disease and related dementias population are nearly $10,000 higher in comparison to the non-Alzheimer's disease and related dementias population.  The legislature also finds that early detection of Alzheimer's disease and related dementias can reduce costs, manage comorbid conditions, delay disease progression, and allow better care planning.  However, data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System found that over two-thirds of people with memory problems in Hawaii have not talked to their health care provider.  Cost may be one factor behind why individuals have not discussed their cognitive health with their health care providers.  According to the Individuals' Interest in Cognitive Screening, Dementia Diagnosis, and Treatment: New Estimates from a Population-Representative Sample report published by the RAND Corporation on December 3, 2024, eighty per cent of study respondents said they would undergo a cognitive assessment if doing so were free.  The legislature notes that medicare beneficiaries who have opted to take Part B coverage already receive an annual cognitive assessment as part of their supplemental coverage.  This assessment can be performed by any practitioner eligible to report evaluation and management services under medicare, including physicians, physician assistants, nurse practitioners, and clinical nurse specialists.  However, this assessment protocol is severely underutilized.  The legislature also finds that broadening the use of cognitive assessments is an important strategy to identify patients who may benefit from current and future treatments for Alzheimer's and related dementias, as assessments provide individuals with information that may facilitate actions to prepare for the future.

     The legislature additionally finds that mandating cognitive assessments for medicare beneficiaries aged sixty-five or older is a necessary component of the State's strategic plan to address Alzheimer's disease and related dementias.  The legislature believes that simultaneously increasing access to cognitive assessments that are already part of many beneficiaries supplemental medicare coverage in conjunction with the public health awareness campaign on Alzheimer's disease and related dementias conducted by the executive office on aging as part of the State's strategic plan will significantly improve the health outcomes for Hawaii's older residents.

     Accordingly, the purpose of this Act is to improve the detection and treatment of Alzheimer's disease and related dementias in Hawaii by mandating cognitive assessments for medicare beneficiaries aged sixty-five or older during annual wellness visits covered by medicare part B.

     SECTION 2.  Chapter 321, Hawaii Revised Statutes, is amended by adding a new part to be appropriately designated and to read as follows:

"Part    .  Cognitive assessments for medicare beneficiaries

     §321-A  Definitions.  As used in this part:

     "Annual wellness visit" means a preventive service visit covered by medicare part B between a medicare beneficiary and a primary care provider that occurs once every twelve months and includes developing or updating a personalized prevention plan and performing a health risk assessment, but does not include a physical exam."

     "Health care provider" means a physician or surgeon licensed under chapter 453 or an advanced practice registered nurse licensed under chapter 457.

     "Medicare" means Title XVIII of the Social Security Act, as amended (42 U.S.C. 1801 et seq.).

     "Medicare part B" means the voluntary supplementary medical insurance benefits program provided under Title XVIII of the Social Security Act (42 U.S.C. 1831–1848).

     "Qualified patient" means an individual medicare beneficiary who is sixty-five years of age or older with coverage under medicare part B .

     §321-B  Cognitive assessments for qualified patients; reporting requirements.  (a)  All health care providers shall conduct or order a cognitive assessment when providing an annual wellness visit to a qualified patient.

     (b)   The cognitive assessment shall be conducted using standardized, validated assessment tools or diagnostic tests approved by the Food and Drug Administration and covered by medicare.

     (c)  A qualified patient may decline the cognitive assessment after being informed of its purpose, benefits, and any risks.  The health care provider shall document the qualified patient's decision to decline the cognitive assessment and include it as a part of the qualified patient's medical record.

     (d)  The health care provider shall provide a report to the executive office on aging no later than October 1 of each year.  The report shall include but not be limited to:

     (1)  Whether the qualified patient declined the cognitive assessment;

     (2)  Whether the qualified patient is exempt from the cognitive assessment and the reason for the exemption;

     (3)  The date of the cognitive assessment;

     (4)  The address where the cognitive assessment was conducted and whether the cognitive assessment was conducted in person or via telehealth;

     (5)  The qualified patient's age, zip code, race, and gender;

     (6)  The type of cognitive assessment administered;

     (7)  The result of the cognitive assessment; and

     (8)  Any follow-up actions taken, including subsequent referrals and further diagnosis and treatment.

     (e)  The executive office on aging shall adopt rules for the secure transmission and storage of the information reported pursuant to subsection (d).

     §321-C  Executive office on aging; annual report; confidentiality; publication.  (a)  The executive office on aging shall provide an annual report summarizing the information collected pursuant to section 321-B to the legislature no later than twenty days prior to the convening of each regular session.  The report shall be available to the public on the department of health's website.

     (b)  Any reports submitted to the legislature and subject to publication under this section shall be limited to aggregated data and shall not directly contain or indirectly result in the disclosure of personally identifiable information.

     (c)  The identity, or any group of facts or any system of records that may lead to the identity, of any qualified patient who has received a cognitive assessment pursuant to this part shall be confidential and shall not be revealed in any report, release, or publication.

     §321-D  Exemptions.  This part shall not apply to:

     (1)  Health care providers who do not accept medicare insurance;

     (2)  Qualified patients who have already received a diagnosis of dementia or mild cognitive impairment; and

     (3)  Qualified patients who are unable to undergo a cognitive assessment due to a physical or mental impairment or disability."

     SECTION 3.  There is appropriated out of the general revenues of the State of Hawaii the sum of $           or so much thereof as may be necessary for fiscal year 2025-2026 and the same sum or so much thereof as may be necessary for fiscal year 2026-2027 for any costs associated with the data management and reporting requirements for the secure data transmission required by this Act.

     The sums appropriated shall be expended by the executive office on aging for the purposes of this Act.

     SECTION 4.  In codifying the new sections added by section 2 of this Act, the revisor of statutes shall substitute appropriate section numbers for the letters used in designating the new sections in this Act.

     SECTION 5.  This Act shall take effect on January 1, 2026; provided that section 3 shall take effect on July 1, 2026.

Report Title:

Cognitive Assessments; Medicare Beneficiaries; Annual Wellness Visits; Alzheimer's Disease and Related Dementias; Reporting Requirements; Executive Office on Aging; Appropriation

Description:

Requires all health care providers who accept Medicare to provide a cognitive assessment as part of the Medicare Part B annual wellness visit for Medicare beneficiaries sixty-five years of age or older, with certain exceptions.  Requires health care providers to submit certain information to the Executive Office on Aging and the Executive Office on Aging to report de-identified aggregated data to the Legislature on an annual basis.  Appropriates funds.  Effective 1/1/2026.

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.