Patient Eligibility for GUIDE

To qualify for GUIDE patients must:

1. Have a qualifying diagnosis, defined as one of the ICD-10 code from the CMS approved list for this programs

2. Have Traditional Medicare (Part A & B) as primary payer

3. Have to have a referral from a GUIDE contracted provider

Enrollment Exclusions

Patients are excluded from GUIDE if they meet any of these criteria:

1. Enrolled in Medicare Advantage, including Special Needs Plans (SNPs)

2. Enrolled in the Program of All-Inclusive Care for the Elderly (PACE)

3. Enrolled in a Memory Care Facility

4. Enrolled in a Long Term Care Facility

5. Enrolled in Assisted Living Facility

6. Has elected the Medicare hospice benefit

7. Is enrolled with another GUIDE participant program

Residence Eligibility Flowchart