Everything You Need to Know for the CMS GUIDE Application

The Centers for Medicare & Medicaid Services (CMS) has released GUIDE, a new model for community-based care for dementia patients. The GUIDE, or Guiding an Improved Dementia Experience, Model is a beacon of progress in dementia care. It emphasizes the essential role of unpaid caregivers and holistic wrap-around services in care for people living with dementia. To take part in this new care model, healthcare providers must apply as an existing or new entity. 

To help potential model participants prepare for the GUIDE application process, we’ve collected the following summary of the program’s intricacies.

Eligibility and Preparation for GUIDE Model Tracks

The GUIDE Model offers two tracks, each catering to different stages of dementia care programs:

1. For Established Programs (July 1, 2024 Start): 

This track is tailored to healthcare professionals  with an established history of providing diverse care services to patients with dementia and their caregivers.  To be eligible for this track, programs must have completed at least one year of comprehensive care services and demonstrated a commitment to multidimensional dementia care.

2. For Newer Dementia Care Programs (2025 Start): 

Targeting programs in the early stages of dementia care, this track includes a preparatory phase for aligning services with GUIDE standards. This provision allows for the development of robust care frameworks and staff training. It acknowledges the complexities of establishing a new dementia program with a high quality of care.

Robust Care Coordination:  Infrastructure and Compliance

A successful GUIDE Model application relies on demonstrating a solid infrastructure, which includes:

• Interdisciplinary Care Team: Emphasizing a team-based approach, this requirement ensures comprehensive care covering the medical, psychological, and social needs of dementia patients. It may include nurses, doctors, and care navigators. 
• Certified Electronic Health Record Technology (CEHRT): Integration of CEHRT is vital for efficient care coordination and data management, facilitating seamless communication among diverse care team members.
• Reporting Requirements: Meticulous documentation and reporting of care delivery and patient outcomes are crucial for continuous program evaluation and improvement.

Understanding the Role of TIN in GUIDE Participation

The GUIDE Model requires participants to operate under a single Taxpayer Identification Number (TIN). This TIN is crucial for aligning a dementia care provider’s National Provider Identifier (NPI) with an approved TIN and the correctly attributed patient. Similar to a majority of Center for Medicare and Medicaid Innovation (CMMI) models, the attribution of patients will be determined through a combination of billed claims linked with a dementia care provider’s NPI.  CMMI will perform regular program integrity screenings on providers and participant partners.  Participants should plan to actively manage a list of participating healthcare providers and partners.    

Comprehensive Application Overview for Healthcare Providers

The overall application process is detailed, with critical needs in the following areas:

1. Care provider participation and attestation
2. Beneficiary eligibility and provider alignment
3. Comprehensive care delivery models
4. Care model tiers
5. Data reporting and sharing

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Dementia Care Provider Participation and Attestation:  

Providers will need to meet one of three threshold criteria:

1. 25% of its patient panel with dementia in the past 5 years; 
2. 25% of patient panel over 65 in the past 5 years; 
3. A specialty designation in neurology, psychiatry, geriatrics, geriatric psychiatry, behavioral neurology, or geriatric neurology. 

The providers will need to then pass CMS Program Integrity Screening to ensure compliance with CMS standards and regulations. Finally, providers will be required to assign billing rights to the TIN participating in the GUIDE model.

Dementia Beneficiary Eligibility and Provider Alignment: 

Beneficiaries will need to be diagnosed with dementia via a set of specific codes by a dementia care provider who meets the attestation requirements. CMMI has provided a list of exclusion criteria. The most important of these exclusions are that patients in Medicare Advantage & PACE are ineligible, as are patients in long-term care facilities.  

Comprehensive Care Delivery Models:

Participants will be required to develop a comprehensive care delivery model covering a variety of areas. These areas are meant to ensure a good quality of life for patients, however, they pose several challenges to providers seeking GUIDE status, since these domains have not been a component of traditional dementia service offerings.  There are nine care delivery domains:

1. Comprehensive assessment 
2. Care planning
3. Ongoing monitoring and support
4. Medication reconciliation and management
5. 24/7 access to a care team member or helpline
6. Care coordination and transitional care management
7. Referrals and coordination for services and supports
8. Caregiver education and support
9. GUIDE Respite Services

Care Model Tiers: 

Understanding how to align your operations with the tier-based system including patient assessments, attribution, care plan development, multi-disciplinary team resources, caregiver support, and outcomes tracking.  Because dementia is a degenerative disease, patients will likely be moving through the tiered model throughout the 8 performance years.

Data Reporting and Sharing: 

GUIDE participants must provide insights into patient outcomes and program performance through meticulous data management.

Harmonic Health: Your Partner in GUIDE Model Success

As health care providers contemplate the GUIDE Model application, Harmonic Health stands out as a partner and resource. Harmonic Health's expertise aligns perfectly with the GUIDE Model, offering:

• Streamlined Operations and RFA Support: Harmonic Health simplifies the complexities of the GUIDE Model application, ensuring compliance and efficiency.  Since 2011, our team has successfully submitted numerous CMMI RFAs across a wide range of models.
• Integrated Care Management Support: With a focus on interdisciplinary care, Harmonic Health provides the necessary infrastructure and resources to meet the GUIDE Model’s comprehensive care requirements. 

Harmonic Health’s interdisciplinary model provides the essential infrastructure required to fulfill the care criteria of the GUIDE model through evidenced-based practices.

• Expertise in Compliance: Understanding the critical role of new TINs and provider alignment in GUIDE participation, Harmonic Health offers guidance in establishing new TINs, contractual arrangements, financial management, and billing practices.

Harmonic Health is not just a service provider but a partner in your journey to enhance dementia care. With Harmonic Health, healthcare providers can confidently navigate the GUIDE Model application, ensuring that their programs are well-positioned for acceptance and success.