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More Details About GUIDE Model Revealed in CMMI/LeadingAge National Webinar

LeadingAge National and the Center for Medicare and Medicaid Innovation (CMMI) presented a webinar last week on the Guiding an Improved Dementia Experience (GUIDE) Model, which will allow Medicare Part B providers and their partner providers to deliver care navigation, educational support, and respite services to individuals with dementia and their caregivers. 

The initial part of the presentation was similar to CMS’s Aug. 10th webinar on the model, the transcript, slides, and recording of which can be found herehere, and here.

The Aug. 30th webinar dedicated over 35 minutes to questions and answers (Q&A) and resulted in the following details being provided. LeadingAge NY will add to this list after we review the recording. 

  • A number of reporting requirements will be required regarding touchpoints for beneficiaries; modalities used; and health equity, social determinants of health, and socioeconomic data documentation. 
  • Annual reassessments will be required for each beneficiary. The Dementia Care Per Month (DCPM) payments account for increased costs during the first six months of care to start the process, including assessments and initial care navigation. 
  • There is no limit of participant partners in each model. Partners can be added as models evolve. CMMI expects each model to serve at least 200 individuals.
  • The Medicare billing clinician or lead should have interoperability with electronic health records (EHRs). Model partners do not necessarily need to have this access. 
  • Each model’s clinician must demonstrate experience in serving individuals with dementia with a patient population that is comprised of at least 25 percent dementia patients. Attestation is required. 
  • The clinician does not need to provide patient and caregiver assessments; a member of an integrated care team may do this. 
  • The Letter of Intent is due Sept. 15th, and the Request for Applications (RFA) will be issued in the fall. CMMI indicated that there will not be another opportunity to participate in this model outside of this process. 
  • There are two types of models: new and established. Established models will already be Part B providers; new models have a pre-implementation year before starting to serve beneficiaries. Established models must meet six of nine care delivery requirements.  
  • DCPM payments will replace some G codes. More information will be released in the RFA.  
  • Quality measures will be phased in by year four. Health equity adjustments will be applied after the initial phases of the model. 
  • There were questions surrounding adult day participation and if beneficiaries could include those currently being served in programs. LeadingAge NY is looking into these options in more detail. 
  • CMMI indicated that telehealth could be the modality for delivering most of these services aside from respite, with the exception of assessments for individuals with severe dementia who will require an in-home assessment visit. 
  • Health care participants serving in the model can define their service area. The 24/7 hotline provider can be outside the service area. 

LeadingAge NY will share the recording of the more recent webinar here once it is available. Please take note of the Sept. 15th due date for Letters of Intent. More information on the GUIDE Model can be found here and here.

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