The application portal for the Guiding an Improved Dementia Experience (GUIDE) model, a new initiative from the Centers for Medicare & Medicaid Services (CMS), is now open. Health care providers are encouraged to apply before the January 30, 2024, deadline. This program aims to foster improvement in dementia care in the United States.
Request for Applications (RFA) Now Available
CMS has released the RFA, detailing the GUIDE model's framework, eligibility, and participation requirements. Providers interested in participating should review the RFA for comprehensive information.
Model Overview and Deadline
The GUIDE model is an eight-year voluntary program, beginning on July 1, 2024, and extending to June 30, 2032. It incentivizes a new approach to providing dementia care, focusing on care management, coordination, and support for Medicare beneficiaries and their caregivers.
Participant Incentives Fact Sheet
A detailed Participant Incentives Fact Sheet is available, providing insights into the benefits and opportunities for participating providers.
Payment Design and Incentives
The GUIDE model introduces a tiered payment system, with monthly Dementia Care Management Payments (DCMP). These payments vary based on the beneficiary's tier, reflecting the complexity of care needs—low, moderate, or high—and length of alignment. Below is a table showing the monthly payment rates listed in the RFA.
Per Beneficiary Per Month Base Payment Rates
Additionally, performance-based adjustments (PBA) and health equity adjustments (HEA) are factored into the payment structure. The PBA measures will be phased in over time, such that in the first year of the model, the maximum adjustment will be +6% to -1%. The HEA will be calculated annually based on area-level and beneficiary-level measures of deprivation and will not begin until the second year of the model.
Equity Score Percentiles and Associate Health Equity Adjustment Amounts
PBA Domains, Measures, and Weights in Later Model Performance Years, Once All Performance Measures Are Phased In
The GUIDE model requires participants provide respite services to eligible aligned beneficiaries and allows them to contract with another organization to do so. Participants will bill for respite services using three new G-codes created for the GUIDE model, and will receive one aggregated payment the following month, subject to an annual cap.
GUIDE participants in the new program track that are considered safety net providers will be eligible to receive an up-front infrastructure payment of $75,000.
These funds are intended to assist with:
- Hiring
- Training
- Developing program workflows, protocols, community partnerships, and materials
- Community outreach and engagement
- Electronic health record technology adaptations
How to Apply
Applications are to be submitted through the GUIDE model website by January 30, 2024. Providers are encouraged to review the RFA thoroughly and prepare their applications accordingly.
We’re Here to Help
If you’re interested in evaluating whether this model is right for your organization, reach out to your Moss Adams professional. We can help you understand:
- If you meet eligibility criteria
- How your payments may be enhanced
- The operational, quality performance, and compliance programs needed to succeed in the model
Additional Resources
Special thanks to Jerry Wei, health care consultant, for his contributions to this article.