alternative payment models

The Centers for Medicare & Medicaid Services (CMS) is currently accepting applications for the Guiding an Improved Dementia Experience (GUIDE) Model, which aims to support people living with dementia and their caregivers. The GUIDE Model will test whether providing an alternative payment methodology for participating dementia care programs to deliver a package of care management and coordination, caregiver education and support, and GUIDE Respite Services to Medicare beneficiaries with dementia and their caregivers reduces expenditures while preserving or enhancing quality of care. Eligible participants include Medicare Part B-enrolled providers or suppliers, excluding durable medical equipment (DME) and laboratory suppliers....

While healthcare payment systems are moving toward paying for value, the unique needs of individuals with I/DD and their families means that the transition toward alternative payment models (APMs) for Medicaid-funded services must be undertaken carefully. This white paper includes 14 payment reform principles to guide the development and assessment of new and emerging APMs for Medicaid I/DD services. The paper also includes 13 recommendations for current and future APMs for I/DD services.