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What is GUIDE?
The Guiding an Improved Dementia Experience (GUIDE) program offers comprehensive care coordination for patients and caregivers living with Dementia, as well as access to in-home or facility-based respite care. All of this is available at no cost to beneficiaries.
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The GUIDE Model will focus on dementia care management and aims to improve quality of life for people living with dementia, reduce strain on their unpaid caregivers, and enable people living with dementia to remain in their homes and communities. It will achieve these goals through a comprehensive package of care coordination and care management, caregiver education and support, and respite services.
Quick Facts
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Expert clinical care for diagnosing and treating the physical, cognitive, and behavioral symptoms of dementia, with appointments available with specialized geriatricians and dementia care providers, no referral needed.
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24/7 care navigation and coordination to assist with scheduling appointments, obtaining medications or equipment, arranging home-based services or transportation, and accessing various supports such as financial or legal planning, meal services, and caregiver training, including support groups.
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Access to integrated behavioral health care, including psychiatrists and therapists, to support both patients and caregivers.
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Respite care services and coordination for those who qualify.
CMS GUIDE
Model Design
​Participants in the GUIDE Model will establish dementia care programs (DCPs) that provide ongoing, longitudinal care and support to people living with dementia through an interdisciplinary team. GUIDE participants will be Medicare Part B enrolled providers/suppliers, excluding durable medical equipment (DME) 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.
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The GUIDE Model aims to address the key drivers of poor-quality dementia care in five ways:​
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Defining a standardized approach to dementia care delivery for model participants – this includes staffing considerations, services for beneficiaries and their unpaid caregivers, and quality standards.
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Providing an alternative payment methodology to model participants – CMS will provide a monthly per-beneficiary payment to support a team-based collaborative care approach.
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Addressing unpaid caregiver needs – the model will aim to address the burden experienced by unpaid caregivers by requiring model participants to provide caregiver training and support services, including 24/7 access to a support line, as well as connections to community-based providers.
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Respite services – CMS will pay model participants for respite services, which are temporary services provided to a beneficiary in their home, at an adult day center, or at a facility that can provide 24-hour care for the purpose of giving the unpaid caregiver temporary breaks from their caregiving responsibilities.
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Screening for Health-Related Social Needs – model participants will be required to screen beneficiaries for psychosocial needs and health-related social needs (HRSNs) and help navigate them to local, community-based organizations to address these needs.