Biden-Harris administration announces new Medicare dementia care model

The Biden administration announced Monday it will be testing a new voluntary care model for people living with dementia and their unpaid caretakers, with the goal of expanding the prevalence of “high-quality, coordinated care.”

According to the Centers for Medicare and Medicaid Services (CMS), the newly announced Guiding an Improved Dementia Experience (GUIDE) Model will test an “alternative payment” for participants who provide supportive services for people with dementia.

In the GUIDE care model, participating providers will establish dementia care programs through which they will assign people with dementia and their caregivers to “care navigators” who will help them in accessing services and support. Unpaid caregivers would also be connected with training programs and education on best practices.

Medicare Part B-enrolled providers who are able to bill for Medicare Physician Fee Schedule services and agree to the requirements of the GUIDE model are eligible to apply. Suppliers of durable medical equipment and laboratory equipment are excluded from eligibility.

CMS noted that many people living with dementia do not receive consistent, quality care, resulting in higher rates of hospitalizations and visits to emergency departments. Families of those with dementia often experience “significant financial, emotional, and logistical burdens,” the agency added.

Unpaid caregivers, friends and family of those with debilitating conditions often provide the only care that a person with dementia receives. AARP estimated that unpaid caregivers in the U.S. provided $600 billion worth of care in 2021. This figure was based on 38 million caregivers in the U.S. spending an average of 18 hours a week on care, with an average value of $16.59 an hour.

A study from the Centers for Disease Control and Prevention (CDC) found that 1 out of 4 baby boomers are caregivers. Among baby boomers, a CDC study found that caregivers have more chronic disease, more disability and lower self-rated health than those in their generation who are not caregivers.

CMS will accept letters of interest for the GUIDE model until Sep. 15. Requests for applications will be sent out over the fall, with the model planned to run for eight years beginning July 1, 2024.