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HR 9823

Alzheimer’s Early Detection Act of 2026

119th Congress Introduced by Jake Auchincloss and 1 co-sponsor

Requires private insurance and Medicaid to cover Alzheimer's biomarker testing with standard, nonrestrictive terms and timely authorizations.

Introduced in House
0
WeVote Research Nonpartisan
Bill Summary · HR 9823

Overview

  • Bill: HR 9823
  • Session: 119th Congress
  • Title: Alzheimer’s Early Detection Act of 2026
  • Purpose: Amend the Public Health Service Act and the Social Security Act to require coverage of Alzheimer’s biomarker testing under group health plans, group and individual health insurance coverage, and the Medicaid program; establish definitions and compliance timelines; and assess the value of such testing through NIH-supported reporting.

What the bill aims to do

  • Require coverage for Alzheimer's biomarker testing:
    • In private insurance (group plans and health insurance issuers offering group or individual coverage).
    • In Medicaid.
  • Ensure testing is covered under the same terms as other medical/surgical benefits, including:
    • No more restrictive financial requirements or cost-sharing.
    • No more restrictive treatment limitations.
    • Timely prior authorization decisions (72 hours, or 24 hours if delay would place life/health at serious risk).
    • Consideration of approval if a prior authorization decision is not made within the specified timeframe.
    • Prohibition of step therapy requirements prior to coverage.
    • Promotion of equitable access, including for rural and underserved populations, with support for minimally invasive testing where appropriate.

Key provisions and definitions

  • Private Insurance (amendment to Part A of title XXVII, Public Health Service Act):

    • New Section 2730: Required coverage of Alzheimer’s biomarker testing.
    • Testing scope includes analyses of tissue, blood, or other biospecimens for biomarkers (including single analyte tests, multiplex panels, protein expression, and sequencing such as whole genome/exome/transcriptome).
    • Testing purposes:
    • Early detection, risk stratification, diagnosis, treatment selection/management, or monitoring of Alzheimer’s disease.
    • Definitions:
    • Biomarker: An objectively measurable indicator of biological processes or pharmacologic responses.
    • Consensus statements and clinical practice guidelines: Clear definitions and standards for evaluating biomarker testing.
    • Effective date: Applies to plan years beginning 1 year after enactment.

  • Medicaid (amendments to the Social Security Act):

    • Adds biomarker testing as medical assistance (new paragraph 32 under 1905(a)).
    • Mandates coverage of biomarker testing for Medicaid in the same manner as required for private plans.
    • Effective date: Applies to calendar quarters beginning 1 year after enactment.

  • Administrative/Study Requirement:

    • A National Institutes of Health (NIH)–contracted study with the National Academies of Sciences, Engineering, and Medicine.
    • Objective: Evaluate the value of biomarker testing in detecting and treating Alzheimer’s disease.
    • Timeline: Report due within 1 year of enactment, and annually for the following two years.

Who is affected

  • Individuals enrolled in:
    • Group health plans.
    • Health insurance coverage (group or individual).
    • Medicaid beneficiaries.
  • Health plans and issuers:
    • Must provide coverage for Alzheimer’s biomarker testing under the outlined terms.
  • Rural and underserved populations:
    • Explicit emphasis on ensuring equitable access and minimizing barriers to testing.
  • Clinicians and testing providers:
    • Subject to prior authorization timelines and coverage determinations as specified.

Key timing and implementation

  • Effective date for private insurance provisions: plan years beginning one year after enactment.
  • Effective date for Medicaid provisions: calendar quarters beginning one year after enactment.
  • Reporting requirement: NIH-led study due within 1 year of enactment, with annual updates for the next two years.

Practical impact

  • Increases access to Alzheimer’s biomarker testing by mandating coverage.
  • Seeks to standardize coverage terms to avoid prohibitive cost-sharing or restrictive limits.
  • Aims to expedite testing through rapid prior authorization decisions.
  • Supports data collection on the value and effectiveness of biomarker testing to inform future policy.

If you’d like, I can summarize potential costs, administrator considerations for plans, or create a side-by-side comparison with current law.

Compiled from official sources — confirm details with the bill’s official record.

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