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

The infrastructure payment is meant for providers who want to develop brand-new dementia care programs and need resources to begin. GUIDE Individuals certified as a security net supplier based upon the percentage of their patient 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 service provider, a brand-new program candidate need to have had a Medicare FFS beneficiary population comprised of a minimum of 36% recipients getting 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 undergo 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 connected with that tier the following month. GUIDE Participants that withdraw or are ended before the start of the second efficiency year will be needed to repay the entire value of their infrastructure payment to CMS.

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After the 2nd performance year, GUIDE Individuals that withdraw or are ended from the GUIDE Model are not required to pay back the infrastructure payment. The main 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 Charge Set Up (PFS) services, consisting of chronic care management and principal 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 design, so GUIDE Individuals will continue to costs under conventional Medicare fee-for-service for all services that are not consisted of under the DCMP. Additional details, consisting of a complete list of duplicative codes, is available in the Request for Applications (Table 8, pg. 35). CMS may add or get rid of codes over time to reflect changes in PFS billing codes.

The care group may include the recipient's medical care supplier, and if not, the care group is required to identify and share details with the beneficiary's medical care company and professionals and describe the care coordination services needed to manage the recipient's dementia and co-occurring conditions. CMS will provide GUIDE Participants information connected to the efficiency determines that CMS utilizes to identify the GUIDE Individual's performance-based change to the DCMP.GUIDE Individuals in the recognized program track need to be prepared to start furnishing services under the GUIDE Design on July 1, 2024, and bill for those services during the Design Efficiency Duration.

Yes, GUIDE recipient and provider overlap with the Shared Cost savings Program is enabled. The GUIDE Model is created to be suitable with other CMS models and programs that intend to improve care and lower costs. CMS believes targeted assistance for people with dementia and their caregivers will help enhance population-based care results in general.

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As an example, if an ACO is getting involved in both the GUIDE Design and the Shared Savings Program during Performance Year 2024 and then renews and begins a brand-new arrangement period as of January 1, 2025, that ACO would have their Shared Cost savings Program benchmark based on 2022, 2023 and 2024, and would have DCMPs counted in Benchmark Year 3. GUIDE Respite Service claims will not be counted toward ACO expenditures, shared cost savings, nor benchmarking beginning in 2024 for the duration of the GUIDE Design.

GUIDE Participants might take part in multiple CMS Development Center designs or Medicare value-based care efforts to speed up development in care shipment, lower the expense of care, and improve population health. Participants and beneficiaries are eligible to participate 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 declares in the REACH ACOs' total expense of care expenses or estimation of shared savings/shared losses.

Overlapping participants need to follow GUIDE billing guidance as set forth below. ACO REACH claim decreases will not apply to DCMP. ACO REACH will include DCMP expenses for functions of positioning estimations. Nevertheless, 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 need to stop billing the Medicare Doctor Cost Schedule Solutions included under the DCMP (See Exhibition 5 in the GUIDE Payment Methodology Paper (PDF)). Participants getting involved in both models need to follow the GUIDE billing requirements in the GUIDE Participation Arrangement and GUIDE Payment Methodology Paper.

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The GUIDE Participant need to not bill Medicare separately for the services offered in the detailed assessment. The detailed assessment (and any re-assessments) is covered by the DCMP. If CMS determines the recipient is not qualified for the GUIDE Model, the GUIDE Participant can bill for a proper Medicare-covered expert service that corresponds to the services rendered.