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CMS Holds Webinar and Issues FAQs on GUIDE Dementia Model – Guiding an Improved Dementia Experience

CMS held a webinar last week on their newly announced GUIDE program – Guiding an Improved Dementia Experience, part of CMS and the White House’s initiative to help support the growing population of individuals with dementia and their caregivers. The webinar recording is here and the slides are here. Additional resources are here: GUIDE FAQs, GUIDE Fact Sheet, CMS web page on the GUIDE model, and national's article: GUIDE Model: A Funding Opportunity for Aging Services Providers.

Save the Date: LeadingAge National will be offering a members-only webinar with the Center for Medicare and Medicaid Innovation on their new dementia focused GUIDE model. The new CMMI model focuses on beneficiaries with dementia and their caregivers residing in the community (including assisted living). More information and registration will be forthcoming. The LeadingAge webinar will be on August 30 from 11:00 AM – 12:30 PM ETYou can register for the webinar here. 

LeadingAge national’s article on the August 10 webinar on the GUIDE model is here. We strongly encourage members to attend national’s August 30th webinar to learn more about why aging services providers should consider applying. 

Request for Applications (RFA) for the GUIDE model will be made available in Fall 2023. The deadline for applications will be provided at that time. Letters of intent are encouraged and may be provided to CMS by September 15, 2023, but are not necessary to participate. 

The GUIDE Model aims to address the key drivers of poor-quality dementia care in five ways:

  1. Defining a standardized approach to dementia care delivery for model participants – this includes staffing considerations, services for beneficiaries and their unpaid caregivers, and quality standards.

  1. Providing an alternative payment methodology to model participants – CMS will provide a monthly per-beneficiary payment to support a team-based collaborative care approach. 

  1. Addressing unpaid caregiver needs – the model will aim to address the burden experienced by unpaid caregivers by requiring model participants to provide caregiver training and support services, including 24/7 access to a support line, as well as connections to community-based providers.  

  1. Respite services – CMS will pay model participants for respite services, which are temporary services provided to a beneficiary in their home, at an adult day center, or at a facility that can provide 24-hour care for the purpose of giving the unpaid caregiver temporary breaks from their caregiving responsibilities.  

  1. Screening for Health-Related Social Needs – model participants will be required to screen beneficiaries for psychosocial needs and health-related social needs (HRSNs) and help navigate them to local, community-based organizations to address these needs. 

Beneficiaries are eligible to receive services under the GUIDE Model if they meet the following criteria:

  • Beneficiary has dementia, as confirmed by attestation from a clinician practicing within a GUIDE dementia care program (DCP).

  • Enrolled in Medicare Parts A and B (not enrolled in Medicare Advantage, including Special Needs Plans, or PACE programs).

  • Have Medicare as their primary payer.

  • Not enrolled in Medicare hospice benefit.

  • Not residing in a nursing home. 

Providers eligible to be GUIDE participants are 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 agree to meet the care delivery requirements of the model.

If the participant can’t meet the GUIDE care delivery requirements alone, they can contract with another Medicare provider/supplier to meet the care delivery requirements. These contracted providers/suppliers will be known as “Partner Organizations.” 

Adult Day Health Care and Social Day Care models, as well as certified and licensed home care providers and other aging services providers, are well positioned to contract with Medicare B providers to provide these services. Providers might consider structuring their participation in a number of ways to participate as a lead provider, or a contract provider delivering only one or more services under the model. LeadingAge New York will be seeking answers to several questions regarding the model, including the expected level of payments for respite and care navigation services and support per member per month.  

Unrelated to the CMMI GUIDE model, but also of potential interest to members, please note the following offering - Community Factors May Support Aging in Place with Dementia – A 3-Day NASEM Virtual Workshop.  The National Academies of Sciences, Engineering, and Medicine, invites interested individuals to a 3-day virtual workshop on Aging in Place with Dementia to discuss the state of knowledge and identify conceptual approaches to guide research on aging in place for people living with dementia in the United States. The sessions will emphasize community and neighborhood level factors that enable aging in place.  The workshop will take place over three consecutive afternoons from September 13 – 15, 12:30 – 4:00 PM ET (4:15 PM on the first day). The workshop is free but you must register in advance. LeadingAge members considering submitting a letter of intent to participate in the upcoming CMMI dementia demonstration might find some items of interest to consider (though there is no relationship between the demonstration and the workshop). 

We will be sure to provide members with additional updates as they are posted by CMS.  

Contact: Meg Everett, meverett@leadingageny.org, 518 867-8871.