CMS to test dementia care model for caregivers, patients

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The Centers for Medicare and Medicaid Services will test a dementia care model that aims to improve quality of life for 6.7 million beneficiaries and their unpaid caregivers, the agency announced Monday.

The eight-year Guiding an Improved Dementia Experience Model (GUIDE) seeks to keep Medicare enrollees outside of long-term care facilities by extending a package of local care coordination and management and caregiver education and support services.

Patients diagnosed with dementia and their caretakers will have access to navigators to help them access meals, transportation and other resources. Participating providers must offer caretakers training, a support hotline and respite services, as well as comprehensive personalized assessments of patient and their caregiver needs and plans for how to connect them to help.

“While we have made tremendous progress in improving care for people with dementia through the National Plan to Address Alzheimer’s Disease, people living with dementia and their caregivers too often struggle to manage their healthcare and connect with key supports that can allow them to remain in their homes and communities,” CMS Administrator Chiquita Brooks-LaSure said in a news release. “Fragmented care contributes to the mental and physical health strain of caring for someone with dementia, as well as the substantial financial burden.”

CMS will give some safety-net providers upfront funding for startup costs. All providers will receive flat, monthly payments based on the number of dementia patients they treat. The pilot program also allows them to bill for respite services offered to caregivers.

“Many of our provider members already dedicate time and resources to educating unpaid caregivers, and need alternative payment models like the one announced today to support those efforts and help keep people in the setting of their choice,” LeadingAge President and CEO Katie Smith Sloan said in a news release. “We appreciate the Biden administration’s attention on how to ensure that unpaid caregivers as well as those they care for are part of how older Americans receive the quality care they need wherever they call home.”

Applications will be available in the fall. Providers that already have dementia care programs in place may begin participating on July 1, 2024. For those that need to establish them, CMS will begin tracking GUIDE performance on July 1, 2025.

The GUIDE model builds on President Joe Biden’s April executive order that directed CMS to improve conditions for caregivers and CMS’ 15-year plan to boost outcomes for dementia patients.

The dementia plan also align’s with CMS’ health equity efforts, Brooks-LaSure said. “We know that Black, Hispanic and Asian Americans, Native Hawaiian and Pacific Islander populations have been particularly disadvantaged in receiving dementia care,” she said. “The GUIDE model will provide new resources and greater access to specialty dementia care in underserved populations and communities.”

CMS has taken other recent steps to address dementia care. Earlier this month, the agency proposed lifting restrictions on the number of PET scans Medicare enrollees can receive to detect amyloid plaques in their brains and announced Medicare will cover Leqembi, a monoclonal antibody Alzheimer’s disease treatment from Biogen and Eisai that costs $26,500 a year.

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