CMS Will Test APM for Medicare Beneficiaries with Dementia, Caregivers

July 31, 2023 - CMS has announced plans to test an alternative payment model (APM) to support Medicare beneficiaries with dementia and their unpaid caregivers.

The Guiding an Improved Dementia Experience (GUIDE) Model will focus on dementia care management and aims to improve the quality of life for people living with dementia, allow them to remain in their homes, and reduce strain on their caregivers.

The Center for Medicare and Medicaid Innovation (CMMI) will test the model, with the first of eight performance years running from July 2024 to July 2025.

“While we have made tremendous progress in improving care for people with dementia through the National Plan to Address Alzheimer’s Disease, people living with dementia and their caregivers too often struggle to manage their healthcare and connect with key supports that can allow them to remain in their homes and communities,” CMS Administrator Chiquita Brooks-LaSure said in the press release.

“Fragmented care contributes to the mental and physical health strain of caring for someone with dementia, as well as the substantial financial burden.”

The GUIDE Model will be available for participants who deliver supportive services to people with dementia, including person-centered assessments and care plans, care coordination, and 24/7 access to a support line.

People with dementia and their caregivers will have access to care navigators who can connect them to clinical and non-clinical services, including meals and transportation through community-based organizations. Caregivers will also have access to training programs on best practices for caring for a loved one living with dementia.

Providers participating in the model can help caregivers receive respite services, allowing them to take temporary breaks from their caregiving responsibilities.

“As millions of Americans already know, dementia can devastate people and their families in many ways. The GUIDE Model aims to mitigate the significant challenges of coordinating and managing healthcare and community-based supports and improve quality of life for patients and caregivers alike,” said CMS Deputy Administrator and Innovation Center Director Liz Fowler.

“By offering caregiver support, respite services, and improved access to community-based supports, the GUIDE Model aims to keep people living with dementia safer and in their homes longer.”

Safety-net providers participating in the new program track will be eligible for a one-time, lump-sum infrastructure payment to support program development activities, according to CMS.

Model participants will receive a monthly per-beneficiary amount for providing care management, care coordination, caregiver education, and support services to beneficiaries and caregivers. Additionally, participants can bill for respite services for beneficiaries with a caregiver and moderate to severe dementia, up to an annual respite cap amount.

Participants must maintain an interdisciplinary care team with a care navigator who has received required training in dementia, assessment, and care planning. Care teams must also include clinicians with dementia proficiency.

The GUIDE Model supports President Biden’s April 2023 Executive Order on Increasing Access to High-Quality Care and Support Caregivers.

In addition, the model supports the Administration’s goal of advancing health equity for underserved communities. Black, Hispanic, Asian American, Native Hawaiian, and Pacific Islander populations have higher rates of dementia, are less likely to receive a diagnosis, and have more unmet needs.

By providing financial and technical assistance for developing dementia care programs targeted to underserved areas, the GUIDE Model aims to improve health outcomes and boost access to dementia care for these populations.

Organizations can submit Letters of Intent to CMS by September 15, 2023, before the application is released in the fall.