GUIDE has two participation tracks. The Established Program Track was for organizations that already ran a dementia care program, and its performance period began on July 1, 2024. The New Program Track was for organizations building one, and it started with a pre-implementation year, with performance beginning on July 1, 2025. Both tracks run through June 30, 2032, and from performance year 2026 they are scored on the same measures with the same payment adjustment range.
This guide explains how the tracks differ in eligibility, timeline, first payment adjustment and support, and what still matters for payment today. It is written for GUIDE program leads and finance teams.
How the Two Tracks Were Defined
According to CMS's GUIDE FAQ, the established program track was for applicants with a practicing interdisciplinary team at the time of the model announcement. That team had to have provided at least 6 of the 9 GUIDE care delivery domains to people living with dementia for at least the 12 months before January 30, 2024. The new program track had a one-year pre-implementation period beginning July 1, 2024, and its performance period began July 1, 2025.
CMS's request for applications gives the purpose. The two tracks let established programs begin performing on July 1, 2024, while giving organizations without a comprehensive community-based dementia care program, including safety net organizations, time and support to build one. CMS said new program development was meant to increase access to specialty dementia care, particularly in underserved communities.
The original application period closed on January 30, 2024. Check CMS's GUIDE page for any later opportunities to participate.
The Timeline Side by Side
Both tracks end on June 30, 2032. The performance year numbering differs. CMS's Performance Measurement Manual now names performance years by the calendar year they start, so this is easier to follow by date:
Established track: performance year 2024 ran July 2024 to June 2025. Its first performance-based adjustment applied from January 2026.
New track: July 2024 to June 2025 was the pre-implementation year. Performance year 2025 ran July 2025 to June 2026, and its first adjustment applies from January 2027.
Both tracks: performance year 2026 runs July 2026 to June 2027, and its adjustment applies from January 2028.
CMS calculates each adjustment three months after the performance year ends and applies it for 12 months, so results reach payment about six months after the year closes.
What the New Track Had to Do Differently
The request for applications describes a lighter start for new program track participants. They used the pre-implementation year for program development, including hiring and training staff, setting up workflows and processes, developing provider networks, and building relationships with community-based organizations and respite providers.
They did not have to meet the care delivery, care team and certified health record technology requirements until two months before their first performance year, by May 1, 2025. By that date they had to submit baseline care delivery reporting and a proposed practitioner roster and partner organization roster. CMS said it would terminate any new track participant that failed to meet these requirements by May 1, 2025, and that participants who had received an infrastructure payment and were terminated would have to repay it.
Applicants to the new track also had to describe plans covering staffing, program protocols and workflows, training, provider network development, and a program director with primary accountability for the program.
The Infrastructure Payment
CMS's participant incentives fact sheet says GUIDE provided a one-time, lump sum infrastructure payment of $75,000 to safety net providers in the new program track in the first year. It was meant to support program development and build organizational capabilities. CMS identified safety net providers by the share of their patients who are eligible for the Medicare Part D Low-Income Subsidy or dually eligible for Medicare and Medicaid.
The fact sheet also lists coaching and facilitation for new track participants among the model's learning supports, alongside peer-to-peer sharing of best practices and data feedback.
How the First Payment Adjustment Differed
This is where the tracks diverged most, and it shows why timing matters for payment.
Potential range in performance year 2025. According to CMS's manual, the performance-based adjustment ranged from -2 percent to +6 percent for established track participants and from -1 percent to +5 percent for new track participants.
Quality of life scoring. In performance year 2025, established track participants were scored on the quality of life measure against a benchmark. New track participants earned a +2 percent contribution for submitting PROMIS-10 data for at least 90 percent of aligned patients.
First adjustment. Established participants saw their first adjustment in January 2026, based on performance year 2024. New track participants see theirs in January 2027, based on performance year 2025.
Data feedback. As of May 2026, CMS's Data Feedback Tool included total per-capita cost and nursing home admission results for established track participants. New track participants receive their data in 2027.
Where the Tracks Converge
From performance year 2026, the manual puts both tracks on the same footing:
The total adjustment ranges from -3.5 percent to +10 percent for both.
All participants are scored on quality of life performance, not just reporting.
The caregiver-reported measure begins to count for both.
The remaining difference is history. Established participants have longer data, an earlier first adjustment and more experience with the measures. New participants are catching up on all three.
Obligations That Applied to Both
Several requirements applied whichever track you joined, according to the request for applications:
Care delivery. Both had to meet the nine care delivery domains and maintain an interdisciplinary care team with a care navigator and a clinician with dementia proficiency.
Alignment. Established participants were required to offer voluntary alignment to all patients with dementia they already served. CMS encouraged participants to reach a minimum of 200 aligned beneficiaries by the end of their second performance year and maintain that level. New beneficiaries can be aligned through June 30, 2031.
Health equity. Both had to develop a health equity plan and report sociodemographic and health-related social needs data.
Annual reporting. Both complete care delivery reporting at least once a year.
What This Means for Planning Today
Know your track's calendar. Your first adjustment, and the year it is based on, depends on it.
Check your case counts. CMS scores a measure only when you meet a minimum, which is 20 eligible patients for most measures. New program participants still building a panel should check each one.
Use the data feedback tool. Established participants can already see cost and nursing home results, and new participants will see theirs in 2027.
Plan for the convergence. Both tracks face the full range from performance year 2026. Treat the caregiver and quality of life surveys as core work.
Confirm current terms. The request for applications dates from 2023. Check your Participation Agreement and CMS's latest manual for any updates.
Where Elli Cares Fits
Whichever track you are on, the work between assessments shapes what CMS measures. Elli Cares gives care teams a clinician dashboard, AI-generated summaries, daily wellbeing check-ins and family observations, so a care navigator can see who may need earlier outreach. Elli doesn't submit CMS reporting, administer the assessment surveys or guarantee measure results. You can read more on our GUIDE page.
Frequently Asked Questions
What is the difference between GUIDE's established and new program tracks?
The established track was for organizations that already provided at least 6 of the 9 care delivery domains to people with dementia for at least 12 months before January 30, 2024, and it began performing on July 1, 2024. The new track was for organizations building a program, with a pre-implementation year and performance beginning July 1, 2025.
When did each GUIDE track start?
The established track's performance period began on July 1, 2024. The new track had a pre-implementation year beginning July 1, 2024, and its performance period began on July 1, 2025.
What is the GUIDE infrastructure payment?
A one-time, lump sum payment of $75,000 for eligible safety net providers in the new program track, in the first year. CMS intended it to support program development.
Do both tracks face the same payment adjustment?
From performance year 2026, yes. CMS's manual sets the range at -3.5 percent to +10 percent for both. In performance year 2025 the ranges differed: -2 percent to +6 percent for established participants and -1 percent to +5 percent for new participants.
Can new organizations still join GUIDE?
The original application period closed on January 30, 2024. Check CMS's GUIDE page for any later opportunities.
