The Centers for Medicare & Medicaid Services (CMS) announced a new voluntary nationwide dementia care model on Monday. Dubbed the Guiding an Improved Dementia Experience (GUIDE) Model, its goal is to “support people living with dementia and their unpaid caregivers.”
But the ramifications of the new model, which is set to go live on July 1, 2024, could be wide ranging. Specifically, the model could offer new reimbursement avenues for home-based care providers of all types.
“Providers can opt into the model and choose whether or not they would want to participate,” Tina Hansen Pickett, a managing director at ATI Advisory, told HHCN. “CMS was making explicit attempts to try to recruit as many providers as possible in their press release event. It is accepting non-binding letters of interest from interested parties through the middle of September, and then more details will be coming out in the fall, and a request for applications.”
The Washington, D.C.-based ATI Advisory is a health care research and advisory services firm.
The plan is for the model to run for eight years after its July 1 launch next year.
Broadly, there’s three areas, in particular, where home-based care providers could potentially step in.
1. “If the participant can’t meet the GUIDE care delivery requirements alone, they have the ability to contract with other Medicare providers/suppliers to meet the care delivery requirements,” CMS wrote in an explainer. In this situation, an unpaid caregiver could potentially enlist an existing home-based care provider to help out. Or, a provider that doesn’t meet all of the necessary requirements could partner with another organization to gain participation.
2. “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,” the explainer read. Respite care is a primary service for many home care providers across the country.
3. “Under the model, participants will assign people with dementia and their caregivers to a care navigator who will help them access services and supports, including clinical services and non-clinical services such as meals and transportation through community-based organizations,” the explainer read. There are many home-based care providers who also offer ancillary and social needs services to better address social determinants of health (SDoH). Those could come in handy under the GUIDE Model.
The Alzheimer’s Association, in a note to HHCN, also confirmed their expectation that home-based care providers will play a role in the model.
“Providers eligible to be GUIDE participants are 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,” CMS wrote.
The GUIDE Model is one way for CMS to test “alternative payment for participants that deliver key services to people with dementia.”
Besides partnership, respite care, and SDoH opportunities, the model’s also of note simply because of its underlying goal, which runs in alignment with home-based care providers’. That goal is to keep older adults with dementia living in their homes and communities for as long as possible. If successful, the GUIDE Model would keep seniors living with dementia out of long-term care facilities and hospitals at a much greater rate.
“I think having caregivers be more trained and more educated as to how to deal with the condition that their loved one is experiencing, that will just better prepare them to work collaboratively with home- and community-based service organizations, too,” Madeleine Howard, a senior analyst at ATI Advisory, told HHCN.
Some of the services that could be paid for under the GUIDE Model – namely SDoH assistance and respite care – have been available under Medicare Advantage (MA) coverage over the last few years with the introduction of primarily health related supplemental benefits and Supplemental Benefits for the Chronically Ill (SSBCI).
CMS sees the model as a possible cost reduction driver, even though it would be reimbursing services that were previously uncovered under traditional Medicare.
“It’s really making sure that caregivers are a part of that care team,” Pickett said. “[To be] really integrated in an acute way as part of the team in the care plans. But its also about assessing what the caregivers need, and then finding support for them and paying for supports. So we think the most interesting part of this model is the ability for Medicare fee for service to be testing some of these caregiver supports through this program.”
Much of the practical details associated with the GUIDE Model are still up in the air. It’s likely providers and caregivers will know much more by the year’s end.
“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. Fragmented care contributes to the mental and physical health strain of caring for someone with dementia, as well as the substantial financial burden,” CMS Administrator Chiquita Brooks-LaSure said in a press release. “We know that Black, Hispanic, and Asian Americans, Native Hawaiian, and Pacific Islander populations have been particularly disadvantaged in receiving dementia care. The GUIDE Model will provide new resources and greater access to specialty dementia care in underserved populations and communities.”
A dementia care focus
Home-based care providers inherently care for many seniors with types of dementia. Increasingly, they’ve trained their caregivers to be able to handle the work that comes with having to care for those patients.
“[Dementia care] is a huge opportunity,” FirstLight Home Care CEO Glee McAnanly said during a panel at HHCN’s’ Home Care Conference last year. “With home care, as we look into the future, I think we need to be thinking about our services more as disease specific.”
The Cincinnati-based FirstLight Home Care is a franchise that has nearly 200 locations throughout the United States.
“We’ve got to meet our clients where they’re at,” McAnanly continued. “We’ve got to meet our caregivers where they’re at and give them the tools to take care of dementia patients. We are building out a training program with certifications for our caregivers, which I think will help them feel better about what they’re doing.”
Quality home care providers are likely already in a position to take advantage of the GUIDE Model, but only time will tell just how involved they’ll be able to get.
Elsewhere, advocacy organizations applauded CMS’ commitment to a better model for dementia care.
“Nonprofit, mission-driven aging service providers know that caring for an older adult with dementia is complex – and that family and friends are a critical part of the care team,” LeadingAge President and CEO Katie Smith Sloan said in a statement shared with HHCN. “Many of our provider members already dedicate time and resources to educating unpaid caregivers, and need alternative payment models like the one announced today to support those efforts and help keep people in the setting of their choice.”
The Washington, D.C.-based LeadingAge represents more than 5,000 nonprofit aging services providers and other mission-minded organizations.
Terry Fulmer, president of The John A. Hartford Foundation, also chimed in to commend the model’s creation.
“The new model for how Medicare will deliver and pay for comprehensive dementia care represents a watershed moment for people with dementia and their family caregivers, who are so often left out of the conversation,” he said. “The GUIDE model can transform care for millions of families living with dementia, helping them get the care and respite they desperately need in the communities they call home.”
Based in New York City, The John A. Hartford Foundation is a private, nonpartisan, national philanthropy dedicated to improving the care of older adults.
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