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GUIDE Individuals have the option, and are not needed, to make readily available break through an adult day center or a 24-hour facility. Extra GUIDE Break Services requirements and information surrounding the payment for such services are specified in the Involvement Agreement. GUIDE Individuals in the brand-new program track that are categorized as safeguard companies will be qualified to get a one-time infrastructure payment of $75,000 (geographically changed by the Geographic Adjustment Aspect [GAF] to cover some of the upfront expenses of establishing a new dementia care program.

The facilities payment is intended for service providers who wish to establish new dementia care programs and need resources to start. GUIDE Participants certified as a security net supplier based on the proportion of their client population that is dually eligible for Medicare and Medicaid or receive the Part D low-income aid.

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To qualify as a GUIDE safeguard supplier, a brand-new program candidate must have had a Medicare FFS recipient population comprised of at least 36% recipients receiving the Part D low-income aid or 33.7% recipients who are dually qualified for Medicare and Medicaid. Accepting the facilities payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE respite services will go through beneficiary cost-sharing.

When an aligned recipient is re-assessed and appointed to a new tier, the GUIDE Participant will be qualified to bill the G-code for the established client payment rate related to that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the 2nd performance year will be required to repay the entire worth of their infrastructure payment to CMS.

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After the second efficiency year, GUIDE Participants that withdraw or are terminated from the GUIDE Design are not required to repay the facilities 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 Fee Schedule (PFS) services, consisting of chronic care management and primary care management, transitional care management, advance care preparation, and technology-based check-ins.

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The GUIDE Design is not a total-cost-of-care model, so GUIDE Participants will continue to expense under traditional Medicare fee-for-service for all services that are not consisted of under the DCMP. CMS might add or remove codes over time to show modifications in PFS billing codes.

The care group may include the recipient's medical care provider, and if not, the care group is needed to identify and share info with the beneficiary's primary care service provider and experts and outline the care coordination services required to manage the beneficiary's dementia and co-occurring conditions. CMS will offer GUIDE Individuals data associated with the efficiency determines that CMS utilizes to identify the GUIDE Participant's performance-based adjustment to the DCMP.GUIDE Individuals in the established program track must be prepared to start furnishing services under the GUIDE Model on July 1, 2024, and bill for those services during the Design Performance Duration.

Yes, GUIDE beneficiary and supplier overlap with the Shared Savings Program is enabled. The GUIDE Design is created to be suitable with other CMS designs and programs that aim to enhance care and minimize costs. CMS thinks targeted assistance for individuals with dementia and their caregivers will assist improve population-based care results overall.

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The Dementia Care Management Payment (DCMP), the per recipient per month GUIDE payment, will be consisted of in 2024 Shared Cost savings Program expenditures. When 2024 ends up being a benchmark year, DCMPs will be included in Shared Cost savings Program benchmark calculations. As an example, if an ACO is taking part in both the GUIDE Design and the Shared Savings Program during Performance Year 2024 and then renews and starts a brand-new arrangement period as of January 1, 2025, that ACO would have their Shared Savings Program standard based upon 2022, 2023 and 2024, and would have DCMPs counted in Criteria Year 3. However, GUIDE Respite Service claims will not be counted towards ACO expenditures, shared savings, nor benchmarking start in 2024 for the period of the GUIDE Design.

GUIDE Participants might take part in several CMS Innovation Center models or Medicare value-based care efforts to speed up innovation in care delivery, decrease the cost of care, and improve population health. Individuals and beneficiaries are eligible to take part in the GUIDE Model and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not consist of the Dementia Care Management Payment (DCMP) or Reprieve Service claims in the REACH ACOs' overall expense of care expenses or calculation of shared savings/shared losses.

Overlapping participants must follow GUIDE billing guidance as set forth below. GUIDE Respite Service claims will not count toward ACO expenses, shared savings, or benchmarking in 2025 and for the duration of the GUIDE Model.

Since January 1, 2025, GUIDE Participants also taking part in ACO REACH must discontinue billing the Medicare Physician Charge Arrange Solutions consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Methodology Paper (PDF)). Individuals taking part in both models must follow the GUIDE billing requirements in the GUIDE Involvement Agreement and GUIDE Payment Methodology Paper.

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The GUIDE Individual should not bill Medicare independently for the services supplied in the comprehensive evaluation. The detailed evaluation (and any re-assessments) is covered by the DCMP. If CMS figures out the beneficiary is not qualified for the GUIDE Model, the GUIDE Individual can bill for an appropriate Medicare-covered professional service that corresponds to the services rendered.