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GUIDE Individuals have the choice, and are not needed, to make offered reprieve through an adult day center or a 24-hour facility. Additional GUIDE Reprieve Providers requirements and information surrounding the payment for such services are defined in the Participation Arrangement.

The infrastructure payment is planned for providers who want to establish brand-new dementia care programs and require resources to begin. GUIDE Individuals certified as a safeguard service provider based on the proportion of their client population that is dually qualified for Medicare and Medicaid or get the Part D low-income aid.

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To certify as a GUIDE safety internet service provider, a new program applicant need to have had a Medicare FFS recipient population made up of a minimum of 36% beneficiaries receiving the Part D low-income subsidy or 33.7% beneficiaries 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 recipient cost-sharing.

When a lined up beneficiary is re-assessed and assigned to a new tier, the GUIDE Individual will be qualified to bill the G-code for the established patient payment rate associated with that tier the following month. GUIDE Individuals that withdraw or are ended before the start of the 2nd performance year will be required to repay the whole worth of their infrastructure payment to CMS.

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After the second performance year, GUIDE Individuals that withdraw or are terminated from the GUIDE Model are not required to repay the infrastructure payment. The primary model 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 Physician Fee 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. CMS may include or eliminate codes over time to reflect changes in PFS billing codes.

The care group may consist of the recipient's primary care company, and if not, the care team is needed to recognize and share details with the beneficiary's medical care service provider and professionals and lay out the care coordination services required to handle the recipient's dementia and co-occurring conditions. CMS will offer GUIDE Participants data associated with the efficiency measures that CMS uses to identify the GUIDE Individual's performance-based modification to the DCMP.GUIDE Participants in the established program track need to be prepared to start providing services under the GUIDE Design on July 1, 2024, and costs for those services throughout the Model Efficiency Duration.

Yes, GUIDE recipient and supplier overlap with the Shared Savings Program is allowed. The GUIDE Design is designed to be compatible with other CMS designs and programs that aim to improve care and reduce spending. CMS thinks targeted assistance for people with dementia and their caretakers will help enhance population-based care results in general.

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As an example, if an ACO is participating in both the GUIDE Design and the Shared Cost Savings Program throughout Efficiency Year 2024 and then restores and begins a new arrangement period as of January 1, 2025, that ACO would have their Shared Savings Program benchmark based on 2022, 2023 and 2024, and would have DCMPs counted in Criteria Year 3. GUIDE Respite Service claims will not be counted toward ACO expenditures, shared savings, nor benchmarking beginning in 2024 for the period of the GUIDE Design.

GUIDE Participants may participate in multiple CMS Development Center designs or Medicare value-based care initiatives to accelerate innovation in care shipment, decrease the cost of care, and improve population health. Participants and recipients are qualified to take part in the GUIDE Design and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not consist of the Dementia Care Management Payment (DCMP) or Break Service claims in the REACH ACOs' total expense of care expenses or computation of shared savings/shared losses.

Overlapping participants ought to follow GUIDE billing guidance as set forth below. ACO REACH claim reductions will not use to DCMP. ACO REACH will consist of DCMP expenditures for purposes of alignment computations. GUIDE Break Service claims will not count towards ACO expenditures, shared cost savings, or benchmarking in 2025 and for the duration of the GUIDE Model.

Since January 1, 2025, GUIDE Individuals also taking part in ACO REACH ought to cease billing the Medicare Doctor Charge Set up Services included under the DCMP (See Display 5 in the GUIDE Payment Methodology Paper (PDF)). Participants getting involved in both models must follow the GUIDE billing requirements in the GUIDE Involvement Agreement and GUIDE Payment Method Paper.

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The GUIDE Individual need to not bill Medicare separately for the services provided in the comprehensive assessment. The thorough evaluation (and any re-assessments) is covered by the DCMP. If CMS identifies the recipient is not qualified for the GUIDE Design, the GUIDE Individual can bill for a proper Medicare-covered expert service that corresponds to the services rendered.