Forging a path to improved dementia care management and outcomes: CMMI announces GUIDE initiative
AOTA Practice and Regulatory Affairs staff, in partnership with member experts, are pleased to announce that our advocacy efforts with the Centers for Medicare & Medicaid Innovation (CMMI) have contributed to a new opportunity for improved funding of dementia care. Sustained roles for occupational therapy practitioners in dementia care management have been difficult to achieve in traditional fee-for-service reimbursement models. The Guiding an Improved Dementia Experience (GUIDE) Model seeks to improve outcomes by offering dementia programs a bundled payment for services provided to beneficiaries enrolled in the program, offering greater flexibility to provide services that meet their long-term needs. While AOTA, and now CMMI, recognize the important contributions that increased occupational therapy services for optimal care management of persons with dementia and their caregivers, this initiative will require occupational therapy practitioners to seek key partnerships with local care providers to ensure that our role is included in this program.
CMS Administrator Chiquita Brooks-LaSure announced the launch of the GUIDE Model at the July 31, 2023, meeting of the Advisory Council on Alzheimer's Research, Care, and Services. AOTA member Jill Cigliana, MSOT, OTR/L, Executive Director of Memory Care Home Solutions, provided public comment at this meeting highlighting occupational therapy's important contributions in providing comprehensive care to people with dementia and their care partners.
CMMI will test the proposed alternative payment model over eight years, from 2024 to 2032, to evaluate the impact and consider the implications of expanding the service model in the future. The outcomes of particular interest to CMMI are improving the quality of life for individuals with dementia and their families, decreasing caregiver stress and strain, and delaying or avoiding nursing home placement. There are clear opportunities for occupational therapy to help a care team address and improve outcomes in each area. To participate, applicants must define a dementia management program (DMP) that offers a comprehensive interprofessional evaluation (including the home environment), a standard approach to client-centered care, as well as caregiver training, education, and support services.
What’s Next? Submit Your Letter of Intent by September 15!
It is critical that the occupational therapy profession seizes this opportunity and claims a role in this program. Including occupational therapy in the GUIDE program will require immediate action to advocate for our services to be directly involved in models submitted for consideration by CMMI participation. Practitioners should first review the CMS webinar and then thoroughly review the additional materials provided to inform advocacy efforts and exploration of local partnerships. CMS is accepting non-binding letters of interest (LOI) for the GUIDE Model through September 15, 2023, and will release a GUIDE Request for Applications (RFA) for the model in Fall 2023. This alternative payment model will launch on July 1, 2024.