GUIDE Program
ABOUT THE GUIDE PROGRAM
The Center for Medicare and Medicaid Services (CMS) introduced the Guiding an Improved Dementia Experience (GUIDE) Model, which is a voluntary nationwide Medicare model test that aims to support people with dementia and their unpaid caregivers. The model began on July 1, 2024, and will run for eight years.
The Center for Elder Care is the only facility in Alabama that has been approved to provide comprehensive dementia care through the GUIDE model. This model provides Medicare coverage for comprehensive, coordinated dementia care. It aims to improve the quality of life for people with dementia, reduce strain on their unpaid caregivers, and enable people with dementia to remain in their homes and communities. It will achieve these goals through Medicare payments for a comprehensive care coordination and care management package, caregiver education and support, and respite services.
Persons living with dementia (PLWD) enrolled in the GUIDE model who have moderate or severe dementia will also have an in-home visit. They may be eligible for limited in-home or adult day care respite service benefits.
WHO IS ELIGIBLE FOR GUIDE?
To be eligible for the CMS GUIDE Model, the patient must meeting the following:
- Has a confirmed diagnosis of Alzheimer’s or other types of dementia
- Has Medicare Part A&B as primary insurance (not under a managed plan)
- Is not enrolled in a Special Needs Plan (SNP) or PACE (Program for All-Inclusive Care for the Elderly)
- Is not enrolled in Medicare hospice benefit
- Is not living in a long-term nursing home
- Lives within the Center for Elder Care service area
ENROLLMENT PROCESS
- A comprehensive appointment is scheduled by the ADC Program administrative team.
- The patient/caregiver completes a required pre-visit questionnaire prior to the assessment.
- The comprehensive assessment is conducted with a Dementia Care Specialist.
- We send information from the appointment to Medicare to determine benefits.
- The patient and caregiver receive continued coordinated care from the ADC program.
GUIDE BENEFITS
HOME VISITS
CMS requires GUIDE enrollees to have a in-home visit in cases of moderate or high complexity dementia and a telemedicine home visit for low complexity patients. A home visit is required for some patients within the program who meet criteria determined by Medicare. A home visit helps ensure that you and your caregiver get additional support and evaluate if any safety measures are recommended.
The UCLA ADC program partners with home care agencies to perform the one-time home visit. The home care agency will contact you directly to arrange a time.
During the home visit, we assess:
- The home environment
- How you function in your home, including performing your personal care tasks
- Other environmental, social and behavioral factors
The home agency visitor will talk with you and walk around your home to evaluate safety and fall risk.
We ask that the patient and caregiver be present for the home visit.
RESPITE FUND
Through GUIDE, Medicare offers a yearly amount for eligible GUIDE enrollees so caregivers can take a break when needed. Eligible UCLA ADC program GUIDE enrollees can receive respite services each year.
Respite service support comes from local in-home respite providers and adult day centers. The UCLA ADC program partners with community-based organizations (CBOs) and home care agencies to provide these services.
Patients enrolled in the GUIDE Model with moderate to high complexity dementia who have a caregiver are eligible for respite services. The respite services fund is available to eligible GUIDE enrollees after completing their initial visit and being aligned within the GUIDE Model.
You can use respite service funds for in-home care or adult day services.
Funds renew on July 1 yearly through the 8-year program. You cannot carry over unused funds to the following year.
GUIDE FAQs
Your GUIDE multidisciplinary team: (left to right):
Julie McCormick, MSN, CRNP, AGPCNP-BC, GS-C
Zaheer Khan, MD
Sue Cheek, Social Worker, LBSW