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GUIDE Participants have the alternative, and are not needed, to make available break through an adult day center or a 24-hour facility. Additional GUIDE Reprieve Services requirements and information surrounding the payment for such services are defined in the Participation Agreement.

The infrastructure payment is intended for suppliers who wish to establish brand-new dementia care programs and require resources to get going. GUIDE Participants qualified as a safeguard service provider based on the proportion of their client 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 safety web service provider, a new program candidate should have had a Medicare FFS recipient population comprised of at least 36% recipients getting the Part D low-income aid or 33.7% beneficiaries who are dually eligible for Medicare and Medicaid. Accepting the facilities payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE break services will be subject to beneficiary cost-sharing.

When an aligned recipient is re-assessed and designated to a new tier, the GUIDE Individual will be eligible to bill the G-code for the recognized patient payment rate related to that tier the following month. GUIDE Individuals that withdraw or are terminated before the start of the second performance year will be needed to pay back the whole value of their infrastructure payment to CMS.

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After the 2nd efficiency year, GUIDE Individuals that withdraw or are ended from the GUIDE Model are not required to pay back the facilities payment. The main 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 Doctor Fee Arrange (PFS) services, consisting of persistent care management and principal 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 model, so GUIDE Individuals will continue to bill under standard Medicare fee-for-service for all services that are not consisted of under the DCMP. CMS may include or eliminate codes over time to show changes in PFS billing codes.

The care team might consist of the recipient's medical care provider, and if not, the care group is required to determine and share information with the beneficiary's primary care supplier and experts and detail the care coordination services needed to handle the beneficiary's dementia and co-occurring conditions. CMS will offer GUIDE Individuals data related to the efficiency determines that CMS utilizes to determine the GUIDE Participant's performance-based adjustment to the DCMP.GUIDE Individuals in the established program track must be prepared to start providing services under the GUIDE Design on July 1, 2024, and expense for those services throughout the Design Efficiency Duration.

Yes, GUIDE beneficiary and company overlap with the Shared Cost savings Program is enabled. The GUIDE Model is developed to be suitable with other CMS models and programs that aim to improve care and reduce spending. CMS believes targeted assistance for individuals with dementia and their caretakers will help enhance population-based care results overall.

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The Dementia Care Management Payment (DCMP), the per beneficiary each month GUIDE payment, will be included in 2024 Shared Savings Program expenditures. When 2024 becomes a benchmark year, DCMPs will be included in Shared Savings Program benchmark estimations. As an example, if an ACO is taking part in both the GUIDE Design and the Shared Savings Program during Efficiency Year 2024 and after that restores and starts a brand-new agreement duration as of January 1, 2025, that ACO would have their Shared Cost savings Program standard based on 2022, 2023 and 2024, and would have DCMPs counted in Standard Year 3. GUIDE Reprieve Service claims will not be counted towards ACO expenditures, shared savings, nor benchmarking beginning in 2024 for the duration of the GUIDE Model.

GUIDE Individuals might take part in several CMS Development Center models or Medicare value-based care initiatives to accelerate innovation in care delivery, decrease the expense of care, and improve population health. Individuals and beneficiaries are eligible to take part in the GUIDE Design and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not include the Dementia Care Management Payment (DCMP) or Respite Service declares in the REACH ACOs' overall cost of care expenses or calculation of shared savings/shared losses.

Overlapping individuals should follow GUIDE billing guidance as stated below. ACO REACH claim decreases will not apply to DCMP. ACO REACH will include DCMP expenditures for functions of alignment computations. Nevertheless, GUIDE Reprieve Service claims will not count towards ACO expenditures, shared savings, or benchmarking in 2025 and throughout of the GUIDE Design.

As of January 1, 2025, GUIDE Individuals likewise taking part in ACO REACH should discontinue billing the Medicare Physician Fee Set up Services included under the DCMP (See Display 5 in the GUIDE Payment Approach Paper (PDF)). Participants participating in both designs should follow the GUIDE billing requirements in the GUIDE Participation Agreement and GUIDE Payment Approach Paper.

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The GUIDE Individual need to not bill Medicare independently for the services provided in the comprehensive assessment. The thorough assessment (and any re-assessments) is covered by the DCMP. If CMS determines the beneficiary is not qualified for the GUIDE Design, the GUIDE Participant can bill for an appropriate Medicare-covered professional service that represents the services rendered.