GUIDE Model Frequently Asked Questions

FAQ Topics:

• Overview
• Patients and Caregivers
• Payment Methodology
• Care Delivery Requirements
• Partner Organizations
• Performance Measurement
• Background

Overview

1. How does the GUIDE Model align with the Innovation Center’s strategy and priorities?

• Promote evidence-based prevention​
• GUIDE promotes evidence-based prevention by focusing on tertiary prevention, evaluating preventive outcomes and maximizing days at home to avoid long-term nursing home care. ​
• Empower people to achieve their health goals​  
• GUIDE’s standardized approach to comprehensive, coordinated dementia care, including caregiver education and support and respite services, directly supports the second strategic pillar of empowering people to achieve their health goals. ​
• Driving choice and competition for people​  

• GUIDE drives patient choice and competition by expanding opportunities for providers to participate in value-based payment programs, as evidenced by more than 300 programs participating in the model.

  GUIDE’s strong emphasis on supporting families and promoting independence makes it a valuable component of the national effort to Make America Healthy Again.​
   

  2. What types of providers participate in the model?

  Health care providers eligible to be GUIDE Participants include Medicare Part B-enrolled providers and suppliers, excluding durable medical equipment (DME) and laboratory suppliers, who are eligible to bill under the Medicare Physician Fee Schedule.
   

  3. Will there be another opportunity for health care organizations to apply to participate in the GUIDE Model in future years?
  
  No, the GUIDE Model had only one application cycle for health care organizations to participate, which closed in early 2024. CMS intentionally designed the GUIDE Model with the understanding that improving outcomes for individuals with dementia and evaluating the value of the model may require the full eight-year duration of the model. 

Patients and Caregivers

4. What are the patient eligibility requirements for the GUIDE Model?
   
   A patient is eligible to receive services under the GUIDE Model if they meet the following criteria:

• Has dementia, as confirmed by attestation from a clinician on the GUIDE Participant’s GUIDE Practitioner Roster;
• Is enrolled in Medicare Parts A and B (not enrolled in Medicare Advantage, including Special Needs Plans, or PACE programs) and has Medicare as their primary payer;
• Is residing in a Private Residence or an approved Residential Care Community that has agreed to partner with a GUIDE Participant (not a long-term nursing home resident and not residing in a Memory Care Unit),
• Has not elected the Medicare hospice benefit, and

• Is not currently aligned to another GUIDE Model Participant.

  A patient will not be disqualified from the model based on other Alzheimer's treatment and/or medications.
   

6. How do I, as a patient, sign up for GUIDE services?

   Step 1: Check if you meet eligibility criteria.

   Step 2: Find a provider serving your area (see Participant List here). Contact a GUIDE doctor or care team to schedule a comprehensive assessment. Assessments can be made in person or virtually, based on your preference. GUIDE is completely voluntary – you can stop at any time, and your regular Medicare benefits continue as usual. You can still see any doctor or hospital that accepts Medicare.

   Step 3: Start GUIDE. Your GUIDE doctor or care team will submit your information to CMS to confirm your eligibility. Your GUIDE doctor or care team will notify you if you are officially enrolled.

   Please see a Fact Sheet for Patients and Caregivers here https://www.cms.gov/priorities/innovation/files/guide-model-patient-caregiver-fs.pdf (PDF)

   You may also contact 1-800-MEDICARE for specific information on questions regarding Medicare benefits.

    

7. Can GUIDE Participants expand their zip-code based service areas over the course of the model?

   Participants may revise their service area throughout the duration of the model (designated by ZIP codes). Participants may select a service area of any size, provided they can deliver all GUIDE Care Delivery Services to patients within the identified service area.

   CMS publicly shares the states that each GUIDE Participant provides services in the GUIDE Participant List:  https://www.cms.gov/files/document/guide-participant-list.xlsx

    

8. Are residents of a residential care community (RCC) eligible patients for the GUIDE Model? What about memory care units?

   Patients who live in a residential care community may qualify for alignment to a GUIDE Participant provided they meet all other eligibility criteria. A patient is considered to reside in an RCC if they live in a congregate living setting that commonly provides supportive services such as housing, meals, assistance with activities of daily living, medication management, supervision, and care coordination. Eligible RCC settings include but are not limited to an assisted living facility, group home, adult family home, board and care homes, and similar congregate residential settings. RCCs do not include settings (including buildings, unit, or bed type) where the patient may receive a Nursing Home level of care.

   Beginning July 1, 2026, GUIDE participants must have an approved partnership arrangement with an RCC before providing GUIDE Model services to patients who reside there. While RCC residents may receive most GUIDE Model services, they are not eligible for GUIDE Respite Services, however, caregivers are still eligible for GUIDE Caregiver Education and Support.

   As of July 2026, patients living in a memory care unit are not eligible for GUIDE. Memory care units provide a secure environment, intensive supervision, and specialized care for individuals with dementia or Alzheimer’s disease and are therefore considered duplicative of GUIDE Model services.

Payment Methodology

9. How will participants be paid under the model?

   The model will pay participants a per patient per month amount, known as a dementia care management payment (DCMP), for providing care management and coordination and caregiver education and support services to patients and caregivers. DCMP rates will be geographically adjusted and adjusted by a Performance Based Adjustment (PBA) to incentivize high-quality care. The GUIDE Model will also pay for a defined amount of respite services for patients who qualify.

   Model participants will use a set of new G-codes created for the GUIDE Model to submit claims for the monthly DCMP and the respite codes. Each model tier will have a different DCMP rate to reflect the fact that covered services and care intensity will vary across the tiers. Respite services will be paid up to an annual cap of $2,500 per patient (adjusted for inflation each year) and will vary in unit costs dependent on the type of respite service used. Additional information can be found in the Payment Methodology Paper: https://www.cms.gov/files/document/guide-payment-methodology-paper.pdf  (PDF)

    

10. Is GUIDE a shared savings model?

    The GUIDE Model is not a shared savings or total cost of care model; it is a condition-specific, longitudinal care model. In general, GUIDE Model participants receive a monthly DCMP for each patient. The GUIDE Model is designed to be compatible with other CMS accountable care models and programs (e.g., ACOs and advanced primary care models) that provide opportunities to improve care and reduce spending.

     

11. Will the GUIDE Model services be subject to patient cost-sharing?

    No, GUIDE Participants are not permitted to charge aligned patients any amount for GUIDE services including respite care. Neither the DCMP nor GUIDE Respite Services will be subject to patient cost-sharing.

Care Delivery Requirements

12. What are GUIDE Participants required to provide as caregiver education and support?

    GUIDE Participants are required to offer a caregiver support program that includes caregiver skills training, information on dementia diagnosis, support group services, and ad hoc one-on-one support calls. Services may be provided either virtually or in person. Caregivers may choose to participate in the services that best meet their needs.

     

13. Does the GUIDE Model support telehealth and virtual visits?

    Yes, many GUIDE services can be delivered virtually, which improves access for patients and caregivers in rural areas and other communities without access to specialized dementia care. One example of this is the initial assessment that may be performed via telehealth or in-person based on the preference of the patient and/or caregiver. Caregiver education and support are additional components of the model that may also be delivered virtually. The only in-person visit requirement is the home visit assessment for certain patients when they are first aligned to a GUIDE Participant.

Partner Organizations

14. What is a GUIDE Partner Organization?

    GUIDE Participants may contract with one or more other providers, suppliers, or organizations, including both Medicare-enrolled and non-Medicare enrolled entities, to meet the care delivery requirements. These providers, suppliers, or organizations will be known as “Partner Organizations.” The GUIDE Participant will be required to maintain a list of Partner Organizations (“Partner Organization Roster”) and update it as changes are made throughout the course of the GUIDE Model.

    Partner Organizations are paid by GUIDE Participants for GUIDE care delivery services that the Partner Organization provides to the GUIDE Participant’s aligned patients. CMS does not directly pay Partner Organizations for services provided under the GUIDE Model. GUIDE Participants and Partner Organizations will determine a payment arrangement and GUIDE Participants must have contracts in place with their Partner Organizations to reflect this payment arrangement. GUIDE Participants are required to pay GUIDE Respite Service Partner Organizations 100% of the total amount paid to the participant. This is known as a “payment pass through.”

    Beginning July 1, 2026, Residential Care Communities (RCCs) are a distinct category of Partner Organization subject to enhanced disclosure, oversight, and patient protection requirements. GUIDE Participants must receive CMS approval to add an RCC to their Partner Organization Roster and must have a fully executed Partner Organization Arrangement with the RCC before providing GUIDE services to patients residing there.

     

15. How can my organization find GUIDE Participants to partner with?

    CMS originally published a participant list in Summer 2024 and continually updates the list on a regular cadence to share GUIDE Participants who are actively serving patients in the model. See the current list here:  https://www.cms.gov/files/document/guide-participant-list.xlsx

Performance Management

16. What performance measures are used for the GUIDE Model?

    CMS has selected performance measures for use in the GUIDE Model, which align with the GUIDE Model’s goals. The five GUIDE performance measures assess the quality and consistency of clinical care, monitor burden on caregivers over time, monitor quality of life for patients over time, and evaluate trends in cost and utilization for patients with dementia. The Performance-Based Adjustment (PBA) methodology will reward participants financially for achieving or exceeding numerical targets for each measure and penalize participants financially for not meeting numerical targets for each measure.

Background

17.   How will CMS evaluate the GUIDE Model?

    The evaluation will use a mixed-methods approach to assess model impacts and implementation experience. All GUIDE Participants are required to cooperate with CMS efforts to conduct an independent evaluation of the model, which may include completion of surveys and participation in interviews, site visits, and other activities that CMS determines necessary to conduct a comprehensive evaluation. In addition, the evaluation contractor may reach out to aligned patients and caregivers and members of the public to gain information about the GUIDE Model.  

    GUIDE Participants are required to collect and report information that will allow CMS to monitor and evaluate the model. This includes, but is not limited to:

• Quality data: GUIDE Participants report quality data on non-claims-based performance metrics on an annual basis;
• Care delivery data: GUIDE Participants respond to a series of questions regarding their implementation of the Model’s care delivery requirements;
• Patient and caregiver assessment data: GUIDE Participants conduct initial assessments of potentially eligible patients and, as applicable, their caregivers, and submit data to CMS, including the patient’s dementia stage, caregiver status, and level of caregiver burden. 

18. Is this model based on existing dementia care programs?

    Yes, the GUIDE Model builds on a substantial body of evidence from both previous CMS models and demonstration projects and external, provider-based dementia care programs. Like the GUIDE Model, these dementia care programs aim to provide comprehensive, interdisciplinary care to people with dementia and their caregivers, with the goal of improving the person and their caregiver’s quality of life while reducing avoidable health care utilization and delaying or avoiding long-term nursing home stays.

     

19. How is GUIDE different from the PACE Program?  

    One of the main differences between the PACE Program and the GUIDE Model is that the GUIDE Model is specifically tailored to Medicare patients with dementia and their unpaid caregivers at any stage of disease including, mild dementia. PACE is a comprehensive health service for all elderly adults categorized as "nursing home eligible." Most of the patients who are in PACE are dually eligible for both Medicare and Medicaid while many GUIDE patients will be enrolled in Medicare but not Medicaid. In addition, unlike PACE, GUIDE is not a total cost-of-care program. Further, the GUIDE Model is a time-limited model test operated by the Center for Medicare and Medicaid Innovation.