Performance year 2026 of the GUIDE Model began on July 1, and it is the first year all five performance measures can affect your payment. The performance-based adjustment (PBA) can raise your monthly Dementia Care Management Payment (DCMP) by up to 10 percent or lower it by up to 3.5 percent.
This guide is for GUIDE program leads, care navigators and clinical directors. It covers how the PBA works, what CMS changed in its May 2026 Performance Measurement Manual, what each measure is worth, and what your team can do this quarter.
What Is the GUIDE Performance-Based Adjustment?
The DCMP is the per-patient, per-month payment that replaces fee-for-service billing for certain care management services. The PBA is a percentage that CMS applies to that payment based on how a participant's aligned patients and caregivers performed on five measures.
Timing matters here. Each performance year runs from July 1 to June 30. CMS calculates the PBA at the end of the year and applies it from the following January for 12 months. The first PBA took effect in January 2026 for Established Program Track participants, based on performance year 2024. New Program Track participants see their first PBA in January 2027, based on performance year 2025. CMS releases each participant's PBA workbook in December.
That schedule has a practical consequence. What your team does between July 2026 and June 2027 sets the adjustment that applies throughout 2028.
What Changed in the May 2026 Performance Measurement Manual?
CMS published version 3.0 of the manual on May 18, 2026. Five changes matter most for planning:
High-risk medications is now a claims-based measure. CMS replaced the participant-reported HRRx measure with a claims-based measure called DAE, developed by NCQA. Participants no longer submit a workbook for it. DAE also adds tracking of antipsychotics and benzodiazepines, two drug classes CMS calls potentially inappropriate for people with dementia.
The quality of life measure was respecified. It is now called Quality of Life for Patients Living with Dementia (QoL-PLWD). It adjusts for patient characteristics such as baseline score, dementia severity, presence of a caregiver and residence type, and it scores the physical and mental health sub-scales of the PROMIS-10 separately.
The caregiver burden measure has new specifications. It is now called Caregiver-Reported Impact in Dementia (CID) and is based on the 22-item Zarit Burden Interview (ZBI-22).
Performance years are named by the calendar year they start. PY 2025 runs July 2025 to June 2026, and PY 2026 runs July 2026 to June 2027.
Benchmarking is better documented. The manual explains how CMS builds the comparison group of GUIDE participants and non-model providers for the claims-based measures.
How Each Measure Works in Performance Year 2026
The five measures map to four domains: care coordination, patient quality of life, caregiver support, and cost and utilization. Here is what each is worth in PY 2026, according to the manual.
Use of High-Risk Medications in Older Adults (DAE): -0.5% to +1%. This is a claims measure for patients 67 and older. It looks at the share with two or more fills of high-risk medications, and lower is better. You report nothing. In PY 2025 it contributed 0%, and CMS had not yet published a PY 2026 benchmark when the manual came out.
Quality of Life for Patients Living with Dementia (QoL-PLWD): -1% to +3%. This uses the PROMIS-10 patient survey. CMS compares the share of patients whose scores were maintained or improved with the share expected given their characteristics, and higher is better. From PY 2026, all participants are scored on performance. In PY 2025, Established Program Track participants were scored against a benchmark of 0.91 on each sub-scale, while New Program Track participants earned +2% for submitting PROMIS-10 data for at least 90 percent of aligned patients.
Caregiver-Reported Impact in Dementia (CID): -1% to +3%. This uses the ZBI-22 completed by identified caregivers, and lower is better. It contributed 0% in PY 2025 because CMS needed another year of data to set a benchmark. It counts from PY 2026, and the benchmark had not been published in the manual.
Total Per-Capita Cost (TPCC): -0.5% to +1.5%. CMS calculates this from claims, and lower is better. The PY 2025 benchmark was 0.95, the 50th percentile of the benchmarking cohort.
Admissions to Long-Term Nursing Home Stay (LTNH): -0.5% to +1.5%. CMS calculates this from claims and Minimum Data Set records, and lower is better. It counts stays of 101 days or more. The PY 2025 benchmark was 0.47, again the 50th percentile.
Add them up and you get the range of -3.5% to +10%. Six of the ten possible points come from the two survey-based measures, QoL-PLWD and CID, so the data collected during assessments carries most of the upside. For comparison, PY 2025 ranged from -2% to +6% for Established Program Track participants and -1% to +5% for New Program Track participants.
What Data Do You Have to Submit, and When?
The three claims measures need no reporting from you. The two survey measures do.
Submit through the PAAF. Participants report assessment data on the Patient Assessment and Alignment Form (PAAF), through the CMS HDR application or, for FHIR-enabled EHRs, a FHIR-based API.
Time the PROMIS-10 correctly. QoL-PLWD needs two responses from the same patient about 12 months apart (plus or minus 60 days). CMS expects the PAAF within 60 days of initial alignment and of each annual assessment.
Collect the ZBI-22 for every identified caregiver. This is required even though CID contributed 0% in PY 2025. If a caregiver or the level of caregiver burden changes, a reassessment is required, along with a new ZBI-22. The PROMIS-10 is not required at reassessments.
Use the PY 2026 template. For assessments tied to PY 2026, CMS says data submitted on earlier PAAF versions may not be accepted.
Know the deadline. The final window for PY 2025 data ran from July 1 to August 31, 2026, and has closed. The PY 2026 window runs from July 1 to August 31, 2027. If you aren't sure your PY 2025 submissions went through, CMS lists a help desk at GUIDEModelTeam@cms.hhs.gov.
Minimum Case Counts: Small Programs Can Lose the Upside
CMS only scores a measure if a participant meets a minimum case count. For DAE, QoL-PLWD, CID and LTNH, that is 20 eligible patients. For TPCC it is 240 patient-months, which equals 20 patients with a full year of data each. If you fall short, you aren't eligible for the PBA on that measure.
Some measures also require patients to have been aligned to you for a minimum period. LTNH and DAE use 90 days, and QoL-PLWD needs the two survey responses described above. Programs still building their aligned panel should check where they stand on each measure, since a measure you can't score is upside you can't earn.
How Day-to-Day Care Shows Up in the Scores
The manual includes an appendix that connects care delivery to each measure. CMS describes it as a supportive reference, not a formal protocol.
A few examples:
Medication safety (DAE): medication reconciliation at the initial assessment, at transitions of care, and on an ongoing basis.
Caregiver impact (CID): the caregiver assessment, 24/7 access to the care team, ongoing care navigator contact, tailored skills training and support, and getting caregivers to use respite.
Cost (TPCC): timely access to the care team and proactive coordination, especially around medications and transitions.
Nursing home admissions (LTNH): advance care planning that includes the caregiver, consistent support from the care navigator, and routine use of respite.
The pattern is that ongoing contact between assessments feeds several measures at once.
Six Things Care Teams Can Do This Quarter
Check your workflow uses the PY 2026 PAAF template. Older versions may be rejected.
Count your patients by measure. Know which measures you currently have enough eligible patients to score.
Schedule assessments so the PROMIS-10 timing works. Plan the second response about 12 months after the first, within the 60-day window.
Make the ZBI-22 routine. Every identified caregiver needs one, and a change in caregiver or burden triggers another.
Watch the Data Feedback Tool. CMS updates it quarterly. As of May 2026, TPCC and LTNH results were available to Established Program Track participants, and New Program Track data follows in 2027.
Use the care delivery appendix in a team meeting. Pick one improvement goal per measure and assign an owner.
Where Between-Visit Visibility Fits
Most of what moves these measures happens between assessments: whether a medication is being taken, whether a caregiver is struggling, whether a patient is heading toward a crisis. A care navigator still has to decide who to call this week.
Elli Cares gives care teams a clinician dashboard, AI-generated summaries, daily wellbeing check-ins, medication reminders and family observations. A navigator can see who may need earlier outreach before the next scheduled contact. Elli doesn't administer the PROMIS-10 or ZBI-22, submit the PAAF, or replace 24/7 clinical access, and it doesn't guarantee better measure performance. It supports the ongoing monitoring and contact that the GUIDE care delivery requirements call for. You can read more on our GUIDE page.
Frequently Asked Questions
What is the GUIDE performance-based adjustment?
The PBA is a percentage that CMS applies to a participant's monthly Dementia Care Management Payment based on performance on five measures. CMS calculates it at the end of each performance year and applies it from the following January for 12 months.
How much can the PBA change payment in performance year 2026?
According to CMS's Performance Measurement Manual, the total PBA potential in PY 2026 ranges from -3.5 percent to +10 percent of the DCMP for both program tracks.
Which measures count in performance year 2026?
Five measures: Use of High-Risk Medications in Older Adults (DAE), Quality of Life for Patients Living with Dementia (QoL-PLWD), Caregiver-Reported Impact in Dementia (CID), Total Per-Capita Cost and Admissions to Long-Term Nursing Home Stay.
When will I see the results of performance year 2026?
PY 2026 ends on June 30, 2027, and the final data submission window closes August 31, 2027. CMS provides PBA workbooks in December 2027, and the adjustment applies from January 2028.
Do Medicare Advantage and PACE patients count in GUIDE?
No. GUIDE aligns patients covered by Original Medicare. Patients enrolled in Medicare Advantage or PACE are not eligible for alignment, according to the manual.
