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This Request for Applications (RFA) introduces the Guiding an Improved Dementia Experience (GUIDE) model, a new Center for Medicare and Medicaid Innovation (Innovation Center) model from the Centers for Medicare & Medicaid Services (CMS). The GUIDE Model will test whether providing an alternative payment methodology for participating dementia care programs to deliver a package of care management and coordination, caregiver education and support, and GUIDE Respite Services to Medicare beneficiaries with dementia and their caregivers reduces expenditures while preserving or enhancing quality of care.
The GUIDE Model is designed to enhance quality of care by improving quality of life for people with dementia and reducing burden and strain on their caregivers. It is expected to reduce Medicare and Medicaid expenditures primarily by preventing or delaying long-term nursing home stays, and secondarily by reducing hospital, emergency department, and post-acute care utilization.
The GUIDE Model is a key deliverable from President Biden’s April 2023 Executive Order on Increasing Access to High-Quality Care and Supporting Caregivers, as well as key goals of the National Plan to Address Alzheimer’s Disease.
The GUIDE Model will be an 8-year voluntary model that is offered nationwide, and will run from July 1, 2024 through June 30, 2032 (“Model Performance Period”). The GUIDE Model will have two participant tracks, one for established dementia care programs and one for new dementia care programs. The first performance year for the established program track will begin on July 1, 2024. The new program track will have a one year pre-implementation period that begins on July 1, 2024, and its first performance year will begin on July 1, 2025.
GUIDE Participants will be Medicare Part B-enrolled providers or suppliers (excluding durable medical equipment (DME) and laboratory suppliers) that establish Dementia Care Programs (“DCPs”) to provide ongoing, longitudinal care to people with dementia (“GUIDE Participant”). A GUIDE Participant must participate in the GUIDE Model under a single, Medicare Part B-enrolled Taxpayer Identification Number (TIN) that is eligible to bill for Medicare Physician Fee Schedule (PFS) services. A GUIDE Participant must meet the care delivery requirements described in the “Care Delivery” section of this RFA but may choose to partner with other organizations, including both Medicare-enrolled providers and suppliers and non Medicare enrolled entities, such as community-based organizations, to meet these requirements.
Eligible beneficiaries will be community dwelling Medicare FFS beneficiaries, including beneficiaries dually eligible for Medicare and Medicaid, who have dementia. Beneficiaries will be aligned to GUIDE Participants through a voluntary alignment process in which they are informed about the GUIDE Model and consent to receive services from a specific GUIDE Participant. Aligned beneficiaries will maintain freedom of choice with respect to their physicians or practitioners.
Beneficiaries will be assigned to one of five model tiers based on the complexity of their needs, and, if applicable, their caregiver needs. Model services, care intensity, and payment will vary by model tier. GUIDE Participants must re-assess each beneficiary at least once per year, and CMS may re-assign beneficiaries to a different model tier based on the results of the re-assessment.
The GUIDE care delivery approach includes
a standardized package of services that GUIDE Participants must provide to beneficiaries and their caregivers (as applicable to individual beneficiary and caregiver needs) (“GUIDE Care Delivery Services”);
an interdisciplinary care team to deliver these services; and
a standardized training requirement for care navigators who are part of the interdisciplinary care team.