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GUIDE Individuals have the alternative, and are not needed, to make offered break through an adult day center or a 24-hour facility. Additional GUIDE Respite Services requirements and details surrounding the payment for such services are specified in the Participation Arrangement. GUIDE Participants in the new program track that are classified as safeguard companies will be eligible to receive a one-time facilities payment of $75,000 (geographically changed by the Geographic Adjustment Aspect [GAF] to cover some of the in advance expenses of developing a brand-new dementia care program.

The infrastructure payment is intended for providers who want to establish brand-new dementia care programs and need resources to get started. GUIDE Individuals qualified as a safety net supplier based upon the proportion of their patient population that is dually eligible for Medicare and Medicaid or get the Part D low-income subsidy.

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To certify as a GUIDE security internet company, a new program candidate must have had a Medicare FFS recipient population comprised of at least 36% beneficiaries getting the Part D low-income subsidy or 33.7% recipients who are dually qualified for Medicare and Medicaid. Accepting the infrastructure payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE reprieve services will undergo recipient cost-sharing.

When an aligned recipient is re-assessed and appointed to a brand-new tier, the GUIDE Individual will be qualified to bill the G-code for the recognized patient payment rate related to that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the 2nd efficiency year will be needed to repay the entire worth of their facilities payment to CMS.

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After the 2nd efficiency year, GUIDE Participants that withdraw or are terminated from the GUIDE Design are not needed to repay the infrastructure payment. The primary design payment under the GUIDE Model is a per-beneficiary, per-month care management payment called the Dementia Care Management Payment (DCMP). The DCMP will replace fee-for-service payment for some existing Medicare Doctor Cost Set Up (PFS) services, including persistent care management and primary care management, transitional care management, advance care preparation, and technology-based check-ins.

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The GUIDE Model is not a total-cost-of-care design, so GUIDE Individuals will continue to bill under traditional Medicare fee-for-service for all services that are not included under the DCMP. Extra information, including a complete list of duplicative codes, is offered in the Demand for Applications (Table 8, pg. 35). CMS might include or remove codes gradually to show changes in PFS billing codes.

The care group may include the beneficiary's primary care supplier, and if not, the care group is required to identify and share info with the beneficiary's main care company and experts and detail the care coordination services needed to manage the recipient's dementia and co-occurring conditions. CMS will offer GUIDE Participants information related to the performance measures that CMS uses to figure out the GUIDE Individual's performance-based modification to the DCMP.GUIDE Participants in the established program track must be prepared to start furnishing services under the GUIDE Design on July 1, 2024, and bill for those services throughout the Design Performance Duration.

Yes, GUIDE beneficiary and provider overlap with the Shared Savings Program is permitted. The GUIDE Model is developed to be suitable with other CMS models and programs that aim to improve care and reduce costs. CMS believes targeted assistance for people with dementia and their caretakers will assist enhance population-based care results in general.

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As an example, if an ACO is participating in both the GUIDE Model and the Shared Savings Program during Performance Year 2024 and then renews and begins a new agreement period as of January 1, 2025, that ACO would have their Shared Cost savings Program benchmark based on 2022, 2023 and 2024, and would have DCMPs counted in Standard Year 3. GUIDE Respite Service claims will not be counted towards ACO expenditures, shared savings, nor benchmarking beginning in 2024 for the duration of the GUIDE Model.

GUIDE Participants may take part in numerous CMS Development Center models or Medicare value-based care efforts to accelerate development in care delivery, lower the cost of care, and improve population health. Individuals and beneficiaries are qualified to take part in the GUIDE Model and the ACO REACH Model. For the rest of CY 2024, ACO REACH will not consist of the Dementia Care Management Payment (DCMP) or Reprieve Service declares in the REACH ACOs' total expense of care expenses or estimation of shared savings/shared losses.

Overlapping individuals must follow GUIDE billing assistance as stated listed below. ACO REACH claim decreases will not apply to DCMP. ACO REACH will consist of DCMP expenses for functions of positioning estimations. Nevertheless, GUIDE Reprieve Service claims will not count toward ACO expenses, shared cost savings, or benchmarking in 2025 and throughout of the GUIDE Model.

As of January 1, 2025, GUIDE Participants also taking part in ACO REACH must discontinue billing the Medicare Doctor Fee Arrange Providers consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Approach Paper (PDF)). Individuals participating in both designs should follow the GUIDE billing requirements in the GUIDE Participation Contract and GUIDE Payment Methodology Paper.

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The GUIDE Individual must not bill Medicare separately for the services supplied in the comprehensive assessment. The extensive assessment (and any re-assessments) is covered by the DCMP. If CMS figures out the recipient is not eligible for the GUIDE Model, the GUIDE Participant can bill for a proper Medicare-covered expert service that corresponds to the services rendered.