; (ii) maintaining functional or cognitive performance; (iii) management of comorbidities and behavioral and safety concerns; and (iv) continued ability to remain in the community. (C) Phase II Subject to the requirements under subsection (c), in determining which models under this subsection to expand under subsection (c), the Secretary shall take into account— (i) any recommendations or strategies identified in the report under section 8 of the Concentrating on High-value Alzheimer's Needs to Get to an End (CHANGE) Act of 2018 ; and (ii) whether the model incorporates care delivery, payment, and evaluation strategies that are likely to demonstrate improved patient outcomes, including the outcomes described in subparagraph (B) and reduced hospitalizations, emergency room visits, and skilled nursing facility stays, without increasing spending under the applicable title. . 4. State innovation models for family caregivers of patients with Alzheimer’s and related dementias Section 1115A(b)(2)(B) of the Social Security Act ( 42 U.S.C. 1315(b)(2)(B) ) is amended by adding the following new clause: (xxv) Allowing States to develop and test programs that increase an Alzheimer's disease patient’s ability to remain in the community by reducing the financial burden to family caregivers, and that include— (I) familial caregiver support services, including training necessary to enable such caregivers to provide services at the level of a home health aide; (II) certification of familial caregiver training and satisfactory completion of testing or other requirements demonstrating caregiver competence; (III) appropriate familial caregiver oversight, including home visits or other activities