Navigating the Decision to Apply to CMS’s GUIDE Model for Dementia Care Management

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ATIWebinars
11/30/2023
AUTHOR – ATI Advisory

Summary

In the November 27, 2023, webinar, “Discovering Pathways of Support: Navigating the Decision to Apply to CMS’s GUIDE Model for Dementia Care Management,” Tyler Cromer and Tina Pickett discussed the GUIDE Program Request for Applications (RFA) and considerations for prospective applicants.  

Considerations for Prospective GUIDE Model Applicants 

Organizations interested in applying for GUIDE should be enrolled in Medicare Part B and eligible to bill under the Medicare Physician Fee Schedule. Organizations will fall into one of two tracks depending on whether they are already delivering the majority of GUIDE’s care delivery requirements (“Established Program Track”) or interested in scaling their program to offer a GUIDE-compliant comprehensive dementia care program (“New Program Track”). If accepted, New Program applicants will have a one-year pre-implementation period to establish their GUIDE program and may have an opportunity to have some implementation expenses partially covered by CMS.

There are four key areas to consider:  

  1. Your program track eligibility. 
  1. Your existing capacity to meet the Model’s care delivery requirements. 
  1. The service area in which you currently operates. 
  1. The financial feasibility of GUIDE Model participation.  

Applications Due January 30

The GUIDE Model offers participants a high degree of flexibility and opportunities for creativity and affords unprecedented supports to both individuals living with dementia and their caregivers. During the session, Cromer and Pickett stressed that interested providers must apply during this cycle, as there are no plans currently for a second round of applications. Applications are due January 30, 2024. 

ATI Advisory is pleased to support organizations in better understanding GUIDE and preparing and applying for Model participation. For those interested in learning more, please reach out to tina@atiadvisory.com and tyler@atiadvisory.com.

FAQs from the Webinar:

Q1: What types of organizations might be especially suitable to participate in the GUIDE Model? 

We see interest in the GUIDE Model from across the senior care industry, including from primary care groups, health systems, PACE organizations, senior living facilities, hospice, home health, and home care organizations. Organizations are well-suited for the Model if they provide care to older adults, have familiarity providing care management and coordination services for individuals with complex conditions, and also have clinical experience caring for individuals with dementia. Organizations interested in Model participation that are able to provide GUIDE’s wraparound care management and caregiver supports  but are not currently enrolled to bill Medicare Part B under the Medicare Physician Fee Schedule (e.g., senior living or home care providers) are encouraged to establish partnerships to meet the application requirements in the GUIDE Model.  

Q2: Is there a start date by which programs must be ready to implement the GUIDE care delivery requirements? 

Established programs must deliver all GUIDE program requirements beginning in July 2024. New programs must have their GUIDE processes and protocols in place by May 2025 and deliver care effective July 2025.

Q3: What characterizes the virtual vs. in-person assessment criteria according to the GUIDE Model? 

Visits with beneficiaries living with mild dementia can be virtual or in-person, and visits with beneficiaries living with moderate or severe dementia must be in-person. 

Q4: Since this is an 8-year program, can an organization wait until Year 2 to apply?

Not at this time. There is a one-time opportunity to apply to the GUIDE model. Interested organizations will need to apply by January 30, 2024 to be considered for participation.

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