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GUIDE Individuals have the option, and are not needed, to make readily available reprieve through an adult day center or a 24-hour facility. Additional GUIDE Break Services requirements and details surrounding the payment for such services are specified in the Involvement Contract.

The infrastructure payment is intended for suppliers who wish to develop new dementia care programs and need resources to get started. GUIDE Participants certified as a security net service provider based upon the proportion of their client 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 company, a brand-new program candidate should have had a Medicare FFS recipient population comprised of a minimum of 36% beneficiaries getting 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 be subject to recipient cost-sharing.

When a lined up recipient 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 Participants that withdraw or are ended before the start of the second performance year will be needed to repay the entire value of their facilities payment to CMS.

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After the 2nd performance year, GUIDE Participants that withdraw or are terminated from the GUIDE Design are not required to pay back the infrastructure payment. The main design payment under the GUIDE Design is a per-beneficiary, per-month care management payment called the Dementia Care Management Payment (DCMP). The DCMP will change fee-for-service payment for some existing Medicare Doctor Cost Schedule (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 Participants will continue to expense under traditional Medicare fee-for-service for all services that are not included under the DCMP. CMS may add or get rid of codes over time to reflect modifications in PFS billing codes.

The care team may consist of the beneficiary's medical care service provider, and if not, the care team is needed to determine and share info with the recipient's medical care provider and professionals and detail the care coordination services needed to handle the beneficiary's dementia and co-occurring conditions. CMS will supply GUIDE Individuals data connected to the efficiency measures that CMS utilizes to determine the GUIDE Individual's performance-based adjustment to the DCMP.GUIDE Participants in the recognized program track should be prepared to begin providing services under the GUIDE Design on July 1, 2024, and expense for those services during the Model Performance Period.

Yes, GUIDE beneficiary and supplier overlap with the Shared Savings Program is enabled. The GUIDE Design is designed to be compatible with other CMS models and programs that aim to improve care and reduce costs. CMS thinks targeted assistance for people with dementia and their caregivers will help improve population-based care results in general.

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The Dementia Care Management Payment (DCMP), the per recipient monthly GUIDE payment, will be included in 2024 Shared Savings Program expenditures. When 2024 becomes a benchmark year, DCMPs will be included in Shared Cost savings Program criteria computations. As an example, if an ACO is taking part in both the GUIDE Design and the Shared Savings Program throughout Performance Year 2024 and after that restores and begins a brand-new arrangement duration as of January 1, 2025, that ACO would have their Shared Cost savings Program criteria based upon 2022, 2023 and 2024, and would have DCMPs counted in Standard Year 3. GUIDE Break Service claims will not be counted towards ACO expenses, shared savings, nor benchmarking beginning in 2024 for the period of the GUIDE Model.

GUIDE Participants might take part in multiple CMS Innovation Center models or Medicare value-based care efforts to accelerate development in care shipment, reduce the expense of care, and improve population health. Individuals and recipients are eligible to take part in the GUIDE Design and the ACO REACH Model. 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' overall expense of care expenses or estimation of shared savings/shared losses.

Overlapping individuals should follow GUIDE billing guidance as stated listed below. ACO REACH claim reductions will not apply to DCMP. ACO REACH will consist of DCMP expenses for functions of alignment computations. However, GUIDE Respite Service claims will not count towards ACO expenses, shared cost savings, or benchmarking in 2025 and for the period of the GUIDE Design.

Since January 1, 2025, GUIDE Individuals also taking part in ACO REACH ought to discontinue billing the Medicare Doctor Fee Schedule Services included under the DCMP (See Display 5 in the GUIDE Payment Methodology Paper (PDF)). Participants taking part in both designs must follow the GUIDE billing requirements in the GUIDE Participation Agreement and GUIDE Payment Methodology Paper.

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The GUIDE Participant should not bill Medicare separately for the services provided in the comprehensive evaluation. The extensive evaluation (and any re-assessments) is covered by the DCMP. If CMS determines the recipient is not eligible for the GUIDE Design, the GUIDE Participant can bill for a suitable Medicare-covered professional service that corresponds to the services rendered.