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GUIDE Individuals have the alternative, and are not required, to make available respite through an adult day center or a 24-hour center. Additional GUIDE Break Solutions requirements and information surrounding the payment for such services are defined in the Participation Contract.

The facilities payment is planned for providers who wish to develop new dementia care programs and require resources to start. GUIDE Participants qualified as a safeguard provider based on the percentage of their client population that is dually eligible for Medicare and Medicaid or get the Part D low-income aid.

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To qualify as a GUIDE safety internet service provider, a brand-new program candidate need to 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 reprieve services will go through recipient cost-sharing.

When an aligned recipient is re-assessed and designated to a new tier, the GUIDE Participant will be eligible to bill the G-code for the established client 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 facilities payment to CMS.

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After the 2nd performance year, GUIDE Participants that withdraw or are ended from the GUIDE Model are not needed to repay the facilities payment. The main design payment under the GUIDE Model 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 Physician Cost Arrange (PFS) services, consisting of persistent care management and primary 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 Participants will continue to expense under traditional Medicare fee-for-service for all services that are not included under the DCMP. Additional information, including a total list of duplicative codes, is offered in the Ask for Applications (Table 8, pg. 35). CMS might include or remove codes over time to reflect changes in PFS billing codes.

The care group may include the recipient's primary care service provider, and if not, the care group is needed to identify and share info with the recipient's medical care service provider and experts and detail the care coordination services needed to handle the recipient's dementia and co-occurring conditions. CMS will supply GUIDE Individuals data related to the performance determines that CMS uses to identify the GUIDE Individual's performance-based adjustment to the DCMP.GUIDE Individuals in the established program track need to be prepared to start providing services under the GUIDE Design on July 1, 2024, and bill for those services during the Model Performance Period.

Yes, GUIDE beneficiary and provider overlap with the Shared Cost savings Program is enabled. The GUIDE Model is created to be compatible with other CMS models and programs that aim to enhance care and lower costs. CMS thinks targeted assistance for individuals with dementia and their caretakers will help improve population-based care results overall.

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The Dementia Care Management Payment (DCMP), the per beneficiary monthly GUIDE payment, will be consisted of in 2024 Shared Cost savings Program expenditures. When 2024 ends up being a benchmark year, DCMPs will be included in Shared Cost savings Program benchmark calculations. As an example, if an ACO is taking part in both the GUIDE Model and the Shared Savings Program throughout Performance Year 2024 and after that renews and starts a brand-new contract 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 Criteria Year 3. GUIDE Reprieve 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 Individuals might take part in several CMS Development Center designs or Medicare value-based care efforts to speed up innovation in care delivery, reduce the expense of care, and enhance 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' overall expense of care expenditures or computation of shared savings/shared losses.

Overlapping individuals must follow GUIDE billing guidance as stated listed below. ACO REACH claim decreases will not use to DCMP. ACO REACH will consist of DCMP expenses for purposes of alignment estimations. Nevertheless, GUIDE Break Service claims will not count towards ACO expenses, shared cost savings, or benchmarking in 2025 and throughout of the GUIDE Design.

Since January 1, 2025, GUIDE Individuals likewise taking part in ACO REACH need to stop billing the Medicare Doctor Cost Set up Services consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Method Paper (PDF)). Participants getting involved in both designs should follow the GUIDE billing requirements in the GUIDE Participation Arrangement and GUIDE Payment Approach Paper.

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The GUIDE Individual should not bill Medicare individually for the services provided in the detailed evaluation. The comprehensive evaluation (and any re-assessments) is covered by the DCMP. If CMS determines the recipient is not eligible for the GUIDE Design, the GUIDE Individual can bill for an appropriate Medicare-covered professional service that represents the services rendered.