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GUIDE Participants have the alternative, and are not required, to make available respite through an adult day center or a 24-hour facility. Additional GUIDE Reprieve Services requirements and details surrounding the payment for such services are specified in the Involvement Agreement.

The facilities payment is intended for companies who want to establish new dementia care programs and require resources to get going. GUIDE Individuals qualified as a security net company based on the proportion of their client population that is dually eligible for Medicare and Medicaid or receive the Part D low-income subsidy.

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To qualify as a GUIDE safeguard supplier, a new program applicant should have had a Medicare FFS recipient population consisted of at least 36% recipients receiving the Part D low-income aid or 33.7% recipients who are dually eligible for Medicare and Medicaid. Accepting the infrastructure payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE respite services will be subject to beneficiary cost-sharing.

When an aligned beneficiary is re-assessed and designated 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 Individuals that withdraw or are terminated before the start of the 2nd efficiency year will be needed to repay the whole worth of their infrastructure payment to CMS.

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After the 2nd performance year, GUIDE Individuals that withdraw or are terminated from the GUIDE Model are not required to repay the facilities payment. The primary design payment under the GUIDE Design 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 Physician Charge Arrange (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 costs under traditional Medicare fee-for-service for all services that are not consisted of under the DCMP. Additional info, including a complete list of duplicative codes, is readily available in the Request for Applications (Table 8, pg. 35). CMS might add or eliminate codes over time to reflect modifications in PFS billing codes.

The care team might consist of the beneficiary's main care company, and if not, the care group is needed to identify and share details with the recipient's medical care company and specialists and outline the care coordination services required to manage the recipient's dementia and co-occurring conditions. CMS will provide GUIDE Individuals information related to the efficiency measures that CMS uses to identify the GUIDE Individual's performance-based change to the DCMP.GUIDE Participants 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 throughout the Model Efficiency Period.

Yes, GUIDE beneficiary and service provider overlap with the Shared Cost savings Program is permitted. The GUIDE Model is designed to be suitable with other CMS models and programs that intend to improve care and reduce spending. CMS thinks targeted support for individuals with dementia and their caregivers will help enhance population-based care results in general.

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The Dementia Care Management Payment (DCMP), the per beneficiary per month GUIDE payment, will be consisted of in 2024 Shared Savings Program expenses. When 2024 becomes a benchmark year, DCMPs will be consisted of in Shared Savings Program benchmark calculations. As an example, if an ACO is taking part in both the GUIDE Design and the Shared Savings Program throughout Performance Year 2024 and then renews and begins a brand-new agreement period as of January 1, 2025, that ACO would have their Shared Savings Program criteria based on 2022, 2023 and 2024, and would have DCMPs counted in Criteria Year 3. GUIDE Break Service claims will not be counted toward ACO expenses, shared cost savings, nor benchmarking beginning in 2024 for the period of the GUIDE Design.

GUIDE Individuals may take part in multiple CMS Development Center designs or Medicare value-based care initiatives to speed up development in care delivery, reduce the expense of care, and enhance population health. Individuals and beneficiaries are eligible 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' overall expense of care expenses or calculation of shared savings/shared losses.

Overlapping participants should follow GUIDE billing assistance as set forth listed below. ACO REACH claim reductions will not use to DCMP. ACO REACH will consist of DCMP expenses for purposes of positioning calculations. However, GUIDE Break Service claims will not count toward ACO expenditures, shared savings, or benchmarking in 2025 and throughout of the GUIDE Design.

Since January 1, 2025, GUIDE Participants also taking part in ACO REACH should discontinue billing the Medicare Doctor Charge Schedule Solutions consisted of under the DCMP (See Exhibition 5 in the GUIDE Payment Methodology Paper (PDF)). Participants taking part in both models should follow the GUIDE billing requirements in the GUIDE Participation Arrangement and GUIDE Payment Methodology Paper.

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The GUIDE Individual should not bill Medicare separately for the services supplied in the thorough assessment. The detailed assessment (and any re-assessments) is covered by the DCMP. If CMS determines the beneficiary is not qualified for the GUIDE Model, the GUIDE Individual can bill for an appropriate Medicare-covered expert service that represents the services rendered.