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However, GUIDE Individuals have the alternative, and are not required, to make offered break through an adult day center or a 24-hour facility. Additional GUIDE Reprieve Services requirements and details surrounding the payment for such services are defined in the Involvement Agreement. GUIDE Individuals in the new program track that are categorized as safety net providers will be eligible to get a one-time infrastructure payment of $75,000 (geographically adjusted by the Geographic Adjustment Aspect [GAF] to cover some of the upfront costs of developing a brand-new dementia care program.

The infrastructure payment is planned for providers who wish to establish new dementia care programs and require resources to start. GUIDE Participants qualified as a safety net service provider based on the percentage 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 qualify as a GUIDE safety internet supplier, a new program applicant should have had a Medicare FFS beneficiary population comprised of at least 36% recipients receiving the Part D low-income aid or 33.7% recipients who are dually qualified 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 an aligned recipient is re-assessed and assigned to a new tier, the GUIDE Individual will be eligible to bill the G-code for the recognized patient payment rate connected with that tier the following month. GUIDE Participants that withdraw or are ended before the start of the 2nd efficiency year will be needed to pay back the entire value of their infrastructure payment to CMS.

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After the second efficiency year, GUIDE Participants that withdraw or are terminated from the GUIDE Model are not required to pay back 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 Cost Schedule (PFS) services, consisting of persistent 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 model, so GUIDE Individuals will continue to bill under conventional Medicare fee-for-service for all services that are not included under the DCMP. CMS may add or remove codes over time to show modifications in PFS billing codes.

The care group might consist of the recipient's main care company, and if not, the care group is needed to determine and share details with the recipient's medical care provider and specialists and detail the care coordination services needed to handle the beneficiary's dementia and co-occurring conditions. CMS will supply GUIDE Participants data connected to the performance determines that CMS uses to determine the GUIDE Individual's performance-based change to the DCMP.GUIDE Participants in the recognized program track must 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 beneficiary and supplier overlap with the Shared Cost savings Program is enabled. The GUIDE Design is designed to be compatible with other CMS designs and programs that aim to enhance care and reduce spending. CMS believes targeted assistance for individuals with dementia and their caretakers will help enhance population-based care results in general.

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The Dementia Care Management Payment (DCMP), the per beneficiary each month GUIDE payment, will be consisted of in 2024 Shared Cost savings Program expenses. When 2024 ends up being a benchmark year, DCMPs will be consisted of in Shared Cost savings Program criteria calculations. As an example, if an ACO is taking part in both the GUIDE Design and the Shared Cost Savings Program throughout Performance Year 2024 and after that renews and starts a new arrangement duration 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 Benchmark Year 3. Nevertheless, GUIDE Respite Service claims will not be counted toward ACO expenditures, shared savings, nor benchmarking start in 2024 for the duration of the GUIDE Model.

GUIDE Individuals may participate in several CMS Innovation Center designs or Medicare value-based care efforts to accelerate innovation in care shipment, lower the cost of care, and enhance population health. Participants and recipients are qualified to take part in the GUIDE Model and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not include the Dementia Care Management Payment (DCMP) or Break Service claims in the REACH ACOs' overall expense of care expenditures or calculation of shared savings/shared losses.

Overlapping participants should follow GUIDE billing assistance as set forth listed below. ACO REACH claim decreases will not apply to DCMP. ACO REACH will consist of DCMP expenditures for functions of alignment estimations. However, GUIDE Respite 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 likewise taking part in ACO REACH ought to terminate billing the Medicare Physician Cost Set up Providers included under the DCMP (See Display 5 in the GUIDE Payment Method Paper (PDF)). Participants participating in both models should follow the GUIDE billing requirements in the GUIDE Involvement Arrangement and GUIDE Payment Method Paper.

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The GUIDE Individual should not bill Medicare separately for the services provided in the detailed assessment. The extensive evaluation (and any re-assessments) is covered by the DCMP. If CMS identifies the beneficiary is not eligible for the GUIDE Design, the GUIDE Individual can bill for an appropriate Medicare-covered expert service that represents the services rendered.