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GUIDE Individuals have the option, and are not required, to make available respite 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.

The infrastructure payment is intended for service providers who want to develop brand-new dementia care programs and require resources to begin. GUIDE Participants qualified as a safety net company based on the percentage of their patient population that is dually eligible for Medicare and Medicaid or get the Part D low-income aid.

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To qualify as a GUIDE safeguard company, a brand-new program candidate must have had a Medicare FFS beneficiary population comprised of at least 36% beneficiaries 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 break services will go through beneficiary cost-sharing.

When a lined up 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 client payment rate connected with that tier the following month. GUIDE Participants that withdraw or are ended before the start of the second performance year will be required to pay back the entire worth of their infrastructure payment to CMS.

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After the 2nd performance year, GUIDE Participants that withdraw or are ended from the GUIDE Design are not required to pay back the facilities payment. The primary model 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 Set Up (PFS) services, including chronic care management and primary care management, transitional care management, advance care planning, and technology-based check-ins.

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The GUIDE Design is not a total-cost-of-care design, so GUIDE Individuals will continue to costs under standard Medicare fee-for-service for all services that are not included under the DCMP. Additional info, including a complete list of duplicative codes, is offered in the Request for Applications (Table 8, pg. 35). CMS might add or eliminate codes with time to show changes in PFS billing codes.

The care group might include the recipient's medical care provider, and if not, the care team is needed to identify and share details with the recipient's main care service provider and specialists and describe the care coordination services required to manage the beneficiary's dementia and co-occurring conditions. CMS will supply GUIDE Individuals information related to the performance determines that CMS utilizes to identify the GUIDE Participant's performance-based change to the DCMP.GUIDE Individuals in the recognized program track need to be prepared to begin furnishing services under the GUIDE Design on July 1, 2024, and expense for those services throughout the Model Performance Period.

Yes, GUIDE beneficiary and supplier overlap with the Shared Savings Program is enabled. The GUIDE Model is designed to be suitable with other CMS designs and programs that intend to improve care and lower spending. CMS believes targeted support for people with dementia and their caregivers will assist improve population-based care outcomes overall.

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As an example, if an ACO is participating in both the GUIDE Model and the Shared Cost Savings Program throughout Performance Year 2024 and then renews and starts a brand-new contract period as of January 1, 2025, that ACO would have their Shared Cost savings Program criteria based on 2022, 2023 and 2024, and would have DCMPs counted in Standard Year 3. GUIDE Reprieve Service claims will not be counted toward ACO expenditures, shared savings, nor benchmarking beginning in 2024 for the period of the GUIDE Design.

GUIDE Individuals might take part in multiple CMS Innovation Center models or Medicare value-based care efforts to accelerate development in care shipment, lower the cost of care, and enhance population health. Participants and beneficiaries are qualified to participate 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 Respite Service declares in the REACH ACOs' overall expense of care expenses or calculation of shared savings/shared losses.

Overlapping individuals need to follow GUIDE billing guidance as set forth listed below. GUIDE Reprieve Service claims will not count toward ACO expenditures, shared cost savings, or benchmarking in 2025 and for the period of the GUIDE Model.

Since January 1, 2025, GUIDE Participants likewise taking part in ACO REACH ought to cease billing the Medicare Physician Cost Arrange Services included under the DCMP (See Display 5 in the GUIDE Payment Method Paper (PDF)). Participants participating in both designs need to follow the GUIDE billing requirements in the GUIDE Involvement Contract and GUIDE Payment Methodology Paper.

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The GUIDE Participant need to not bill Medicare individually for the services supplied in the detailed assessment. The comprehensive assessment (and any re-assessments) is covered by the DCMP. If CMS figures out the beneficiary is not qualified for the GUIDE Design, the GUIDE Participant can bill for a proper Medicare-covered expert service that represents the services rendered.