New Dementia Support Available: The GUIDE Program

If you or a loved one have been diagnosed with mild, moderate, or severe dementia, you may be eligible for support through the federal government’s program, Guiding an Improved Dementia Experience (GUIDE).

Program Highlights

• Services are available at no cost for eligible Medicare beneficiaries.
• Comprehensive assessments to understand specific challenges and strengths of each individual and caregiver, and a personalized care plan tailored for the person living with dementia and which adapts as needs evolve.
• Care coordination with the individual’s health care providers. You do not need to change your doctor to participate in the program.
• Your own dementia-specialized Care Navigator (Massachusetts) or Nurse For Life (New Hampshire) who checks in regularly to monitor health and support caregivers, with 24/7 access to your care team.
• Family caregivers receive customized training and education on how to best care for a person living with dementia and $2,625 in annual respite care services for qualifying families, equivalent to 76 hours of in-home care.
• Ongoing support with regular check-ins to help you navigate the complexities of dementia care with confidence.

Overview

• Eligibility = Has dementia, Traditional Medicare Parts A & B as primary insurance, not currently enrolled in hospice, lives at home.
• 1 GUIDE Unit = 4 hours. Whenever possible, visits should be scheduled in 4-hour blocks, 19 blocks a year. More than 1 block a day can be used.
• If a client requests a shorter visit, discuss with your manager. We can bill in increments of 4 hours for the month. For example, 4 3-hour blocks can be billed out as 3 units, 12 hours, at the end of a month.
• GUIDE year runs 7/1-6/30. Hours are renewed automatically every July 1st.
• Offices should contact the Care Navigator (Massachusetts) or Nurse For Life (New Hampshire) to determine if the client wants to continue services with GA.
• Visit notes are required for billing.
• GUIDE Care Navigator (Massachusetts) or Nurse For Life (New Hampshire) will provide a Care Plan. GA should still send out a nurse to assess for matching.
• The client loses any hours not used in a fiscal year.

Generations Entry Specifications

• Request GA nurse to do the evaluation. This is a billable visit, GUIDE RN.
• When scheduling, identify caregivers that have completed GA dementia training or are willing to work toward completion.
• Add to Caregiver Alert: Visit Notes must be entered for every visit.
• Client Type: GUIDE, will need to create more types if existing client has additional payor sources.
• Secondary Payor: Guide Program.
• Assign a task to all shifts: Visit Note.
• Tracking: Putting an available shift toward the end of the 19 blocks with a note is a tool so as not to go over authorization and to ask the client if they are interested in ongoing private pay services once exhausted. For those that use hours sporadically, check visit history prior to scheduling. Putting total used hours in Visit Note and updating Phone 2 each time are other strategies for tracking.
• Add Care Plan to Care Plan Attachments.
• Phone 2 = 76 annual hours.
• Assign CC to PP Billing informing that it is a new GUIDE client.
• Have assigned CM reach out to Navigator to establish ongoing communication.
• Enter Navigator in Client Contacts and alerts to keep them in the loop.

Eligibility

A person is eligible to receive services under the GUIDE program if they meet the following criteria:

• Has dementia. AgeSpan (Massachusetts) or PocketRN (New Hampshire) can help obtain a diagnosis if appropriate.
• Has Traditional Medicare Parts A & B as primary insurance, not Medicare Advantage.
• Is not currently enrolled in hospice.
• Lives at home. Temporary rehab stays and independent living are allowed.

VA patients, dually eligible Medicaid patients, and palliative care patients may be eligible.

Not Eligible If

You are not eligible if you are enrolled in:

• Medicare Advantage, including Special Needs Plans or PACE programs.
• Hospice.
• Program of All-Inclusive Care for the Elderly (PACE).
• Or if you are a long-term nursing home resident.

About the Program Partnership