1. Executive Summary and Strategic Context

The GUIDE Model is an 8-year voluntary nationwide alternative payment model (July 1, 2024 through June 30, 2032) providing comprehensive dementia care services to Medicare fee-for-service beneficiaries and their unpaid caregivers. With 390 participating organizations across 46 states, GUIDE is the first CMS Innovation Center model to provide Medicare coverage for dementia-specific wraparound services including care navigation, caregiver training, respite care, and 24/7 support lines.

Approximately 6.7 million Americans live with dementia, a number expected to double by 2060. About 10.7% of Medicare beneficiaries have a dementia diagnosis. These patients experience fragmented care, high hospitalization rates, frequent ED visits, and disproportionate post-acute care utilization. Unpaid caregivers provide the majority of support at enormous personal, financial, and emotional cost.

1.1 Strategic Significance

GUIDE is unique among CMMI models: it targets a specific disease rather than a care episode or payment mechanism; it explicitly includes unpaid caregivers as beneficiaries of services; and it generates savings primarily through reduced Medicaid long-term nursing home placement rather than Medicare FFS spending reduction. GUIDE is compatible with ACO REACH and MSSP, enabling layered participation strategies.

2. Model Architecture

2.1 Participation Structure

Track	Organizations	Launch Date	Description
Established Program	96 organizations	July 1, 2024	Existing dementia care programs ready for immediate performance
New Program	294 organizations	July 1, 2025	Pre-implementation year to build dementia care program

2.2 Participant Requirements

Eligible Organizations: Medicare Part B-enrolled providers and suppliers. Single or partnered organizations.

Interdisciplinary Care Team: Minimum: care navigator + dementia-proficient clinician (25%+ panel with cognitive impairment AND 25%+ aged 65+, OR specialty in neurology/psychiatry/geriatrics).

Partner Organizations: Respite providers, adult day centers, hospitals, community-based organizations, home health agencies.

Safety Net Infrastructure Payment: $75,000 one-time lump sum for New Program Track safety net providers.

2.3 Beneficiary Eligibility

Community-dwelling Medicare FFS beneficiaries (including dually eligible) with attested dementia diagnosis. Excludes: hospice recipients, nursing home residents, MA/SNP/PACE enrollees. Voluntary consent/alignment required.

3. Payment Mechanics

3.1 Dementia Care Management Payment (DCMP)

Monthly per-beneficiary-per-month payment covering care management, coordination, caregiver education, 24/7 support line, medication management, and HRSN screening/navigation. Rates adjusted by:

Dementia Severity: Tiered by mild, moderate, or severe staging.

Caregiver Status: Higher payments for beneficiaries with identified unpaid caregivers.

New vs. Established: Higher initial DCMP for new beneficiary intake assessment.

Health Equity Adjustment (HEA): Increased payments for disadvantaged populations.

Performance-Based Adjustment (PBA): Quality measure performance modifications.

3.2 Respite Care Payment

Annual cap of $2,500 per beneficiary ($2,563 in 2025) for respite services in three settings: in-home, adult day center, or facility-based 24-hour care. Available only for beneficiaries with unpaid caregiver and moderate-to-severe dementia.

3.3 Expected Savings Pathway

GUIDE is NOT expected to generate Medicare savings. Primary savings from reduced FMAP spending through delayed/prevented Medicaid-funded nursing home placement. This cross-title savings approach is novel for CMMI.