CMS Unveils Dementia-Focused Payment Model with Interdisciplinary Care Approach

Hospice News | By Jim Parker

The U.S. Centers for Medicare & Medicaid Services (CMS) has unveiled a new payment model demonstration geared toward dementia-related illnesses, which are becoming more prevalent among hospice patients.

The Guiding an Improved Dementia Experience (GUIDE) Model is designed to improve the quality of life for dementia patients and their caregivers by addressing behavioral health and functional needs, as well as better coordinating care and improving care transitions between community, hospital and post-acute settings.

“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 health care and connect with key supports that can allow them to remain in their homes and communities,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “Fragmented care contributes to the mental and physical health strain of caring for someone with dementia, as well as the substantial financial burden.”

Participating patients and families will also have access to a care navigator to help them access clinical and non-medical services.

Patients will be stratified into one of five tiers, based on a combination of their disease stage and caregiver status. Care intensity and payment increase by tier, according to CMS.

Reimbursement through the model includes a per-member, per-month payment, as well as an infrastructure payment for some safety net providers. Participating operators may also receive payment for respite care.

Patients who have elected the Medicare Hospice Benefit are not eligible for the program. However, hospice and palliative care providers that offer upstream services may be uniquely suited to implement such a model, either directly or through a partnership.

GUIDE involves a trained interdisciplinary care team that delivers a standardized set of services based on a person-centered care plan, according to CMS.

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GUIDE Webinar

CMS will host a webinar to provide more information on the GUIDE Model. During the session, the GUIDE team will discuss the goals of the model, participant and beneficiary eligibility criteria, care delivery requirements, and model payment.

  • Date: Thursday, August 10 at 2 p.m. – 3 p.m. ET
  • Registration: To register, click here

Interested in GUIDE?