Medicare beneficiaries with dementia could have better access to coordinated care under a model announced Monday by the Centers for Medicare & Medicaid Services (CMS).
“The current system of care for people with dementia can be very fragmented and siloed,” CMS Administrator Chiquita Brooks-LaSure said Monday morning in a speech at a meeting of the National Alzheimer’s Project Act Advisory Council. “This results in poor outcomes, duplicative and depersonalized services, and severe impacts on the quality of life for caregivers, who often provide significant amounts of assistance with personal care, finances, household management, clinical coordination, and other care. Additionally, fragmented care often leads to substantial financial burden, increased caregiving demands, and physical and mental strain for those caring for someone with dementia.”
The new model, known as Guiding an Improved Dementia Experience (GUIDE), is a “first-of-its-kind initiative for CMS designed to support both those living with dementia and those caring for them,” she said. “It also advances President Biden’s landmark April 2023 Executive Order on increasing access to high-quality care and supporting caregivers … Specifically, the GUIDE Model will include a sustainable alternative payment model that offers standardized dementia care, including assessments, care coordination, ongoing monitoring, medication management, and a 24/7 support line.”
She listed the model’s three main goals: to improve the quality of life for people with dementia; to reduce strain on their unpaid caregivers; and to help people remain in their homes and communities, preventing or delaying long-term nursing placement.
GUIDE participants will be Medicare Part B-enrolled providers/suppliers — except for durable medical equipment 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, according to a CMS webpage. Participants in the GUIDE Model will establish dementia care programs that provide ongoing, longitudinal care and support to people living with dementia through an interdisciplinary team.
If a participant can’t meet the GUIDE care delivery requirements alone, they have the ability to contract with other Medicare providers/suppliers, known as “partner organizations,” to meet the care delivery requirements. CMS will provide a monthly per-beneficiary payment under the model in order to support a team-based collaborative care approach.
Among their other responsibilities, model participants will be required to screen beneficiaries for psychosocial needs and health-related social needs and help navigate them to local, community-based organizations to address these needs, according to the agency. CMS will pay model participants for respite services — the temporary services provided to a beneficiary in their home, at an adult day center, or at a facility that can provide 24-hour care — in order to give unpaid caregivers temporary breaks from their caregiving responsibilities.
The 8-year model will offer two tracks: one for established programs and one for new programs. Established programs must have an interdisciplinary care team (including a care navigator), use an electronic health record platform that meets the standards for certified electronic health record technology, and meet other care delivery requirements. New programs must not be operating a comprehensive community-based dementia care program at the time of model announcement and will have a 1-year pre-implementation period to establish their programs.
Brooks-LaSure noted the issue was a personal one for her because her grandmother suffered from dementia for the last decade of her life. “I remember so vividly when she couldn’t even remember that she had just eaten her birthday cake, even though the empty plate was standing there,” Brooks-LaSure said. “Or looking at my father and saying ‘You’re too old to be my son,’ because, you know, her mind was where she was in her 40s and 50s. So I just say that [to show] how personally invested I have been in looking at how we think at CMS about how we are incorporating caregivers in our work.”
CMS is accepting letters of interest for the GUIDE Model through Sept. 15, 2023, and will release a GUIDE Request for Applications for the model in Fall 2023, CMS said. The model will launch on July 1, 2024, and run for 8 years.
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Joyce Frieden oversees MedPage Today’s Washington coverage, including stories about Congress, the White House, the Supreme Court, healthcare trade associations, and federal agencies. She has 35 years of experience covering health policy. Follow
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