Last week, the Centers for Medicare and Medicaid (CMS) released the Guiding an Improved Dementia Experience (GUIDE) Model aimed at improving the way dementia care is delivered and supporting unpaid caregivers. The goal is to help those living with Alzheimer’s disease and dementia remain in their homes and communities, thereby minimizing hospitalizations, post-acute and long-term care through improved care coordination and management, caregiver education and support, and respite services. This is part of the Biden Administration’s goal to increase high quality care and support caregivers. Through GUIDE, CMS will test an alternative payment for participants that deliver key supportive services to people with dementia.
CMS will host a webinar on Thursday, August 10 at 2:00 p.m. EST, on the GUIDE model offering information on the goals of the model, participant and beneficiary eligibility, care delivery requirements and model payment. Registration is available via Zoom.
This announcement included some basic model parameters with additional details to be included in the Request for Applications (RFA) released this fall. CMS is accepting letters of interest for the GUIDE Model through September 15, 2023.
- GUIDE participants will be Medicare Part B enrolled providers/suppliers, excluding durable medical equipment (DME) and laboratory suppliers, who are eligible to bill for Medicare Physician Fee Schedule services and who agree to meet the care delivery requirements.
- Participants who can’t meet the GUIDE care delivery requirements alone, are able to contract with other Medicare providers/suppliers known as “Partner Organizations” to meet the care delivery requirements.
- There are two tracks, one for established programs and one for new programs (those that do not have prior APM experience or comprehensive dementia care programs).
- Established programs are required to have an interdisciplinary care team, including a care navigator, use a certified electronic health record platform, and meet other care delivery requirements as outlined in the RFA.
- New programs must not be operating a comprehensive community-based DCP at the time of model announcement and will have a one-year pre-implementation period to establish their programs.
- The GUIDE model also incorporates strategies to improve health equity, a Biden Administration key priority, such as requiring participating providers to implement health-related social needs (HRSN) screenings and referrals, offering financial and technical support for new dementia care programs targeted to underserved areas, a health equity adjustment to the model’s per member per month care management payment to provide additional resources to care for underserved beneficiaries.
CMS continues to double-down on the goal to have 100 percent of people with traditional Medicare in accountable care relationships with providers who are responsible for the quality and total costs of their care by 2030. The main driver for CMS continues to be their ACO strategy and it is important for long term care providers to learn and engage.
For questions, additional information regarding AHCA/NCAL efforts regarding value based care and population health, please reach out to Nisha Hammel, Associate Vice President of Population Health Management at nhammel@ahca.org.