CMS announces Medicare dementia care model

Following significant direct input and advocacy from AOTA members and staff over the past year, the Centers for Medicare & Medicaid Services (CMS) announced a new voluntary nationwide care model – the Guiding an Improved Dementia Experience (GUIDE) Model on July 31, 2023. The GUIDE Model aims to improve the quality of life for people living with dementia, reduce strain on unpaid caregivers, and help people remain in their homes and communities through a package of care coordination and management, caregiver education and support, and respite services.

The Center for Medicare and Medicaid Innovation (CMMI) will implement the GUIDE Model as a demonstration project to test and evaluate the impact of this new coordinated care delivery model over eight years. The GUIDE Model offers an exciting opportunity to improve access to occupational therapy services for families and caregivers coping with dementia challenges. This program also supports the need for occupational therapy access to three new caregiver training codes that are proposed in the Medicare Fee Schedule Proposed Rule and will help advance the best possible outcomes for dementia patients.

AOTA staff and dementia experts met with CMMI on numerous occasions beginning in December 2022 to discuss various existing dementia care approaches and to share the assessments and interventions that are most critical for Medicare patient quality and therapeutic outcomes, including how occupational therapy can meet caregiver training and burden reduction needs. AOTA continues to dialogue with CMS and CMMI staff about this important model and will be monitoring all activities closely.

This demonstration project is not passive or automatic, but rather is voluntary and will require proactive action by interested clinicians, like you! AOTA is optimistic that the role and value of occupational therapy in advancing coordinated care for individuals and their families will become increasingly clear in a health care system that has traditionally been more focused on cure than care. However, that can’t happen unless occupational therapy practitioners do the necessary research and apply to be part of this program. We strongly encourage occupational therapy practitioners to educate their employers and care systems to proactively advocate for inclusion in this CMMI demonstration program by applying to participate in this demonstration project. Applications will be due in the Fall of 2023.