If you are a Medicare Part B enrolled Provider and already provide comprehensive dementia care you may be eligible to enroll those you care for in the CMS GUIDE program.

Use this handy tool to determine their eligibility (and your reimbursement).

Is their Dementia considered Mild, Moderate, or Severe?

Dementia diagnosis has not been confirmed

In order to participate, your Patient will need a Dementia Diagnosis confirmed by attestation from a clinician practicing with a participating GUIDE dementia care program.

Is the Patient enrolled in Medicare

Parts A & B?

Patient not enrolled in Medicare

Parts A & B

In order to participate, your Patient will need to be enrolled in Medicare Parts A & B.

In your Patient residing in a Long-Term Nursing Home or are they enrolled in a PACE program or Medicare Hospice?

Residing in Long-Term Nursing Home or  enrolled in Medicare Hospice or PACE Program.

Unfortunately your Patient does not qualify for the GUIDE program.

In order to qualify, they cannot be:

• Residing in a Long-Term Nursing Home
• Enrolled in Medicate Hospice
• Enrolled in PACE

Does your Patient currently have an unpaid Caregiver (family or otherwise)?

GUIDE Reimbursement

Your Patient would be on the Low Complexity Dyad Tier.

Month Payment Rates

GUIDE Reimbursement

Your Patient would be on the Moderate to High Complexity Individual Tier.

Month Payment Rates

How would you rate the strain or burden on the Patient’s Caregiver?

CMS Recommends using a consistent assessment tool similar to the Zarit Caregiver Buden Interview (ZBI).

GUIDE Reimbursement

Your Patient would be on the Low complexity dyad tier.

Month Payment Rates

GUIDE Reimbursement

Your Patient would be on the Moderate complexity dyad tier.

Month Payment Rates

GUIDE Reimbursement

Your Patient would be on the High complexity dyad tier.

Month Payment Rates