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GUIDE Individuals have the option, and are not required, to make offered break through an adult day center or a 24-hour center. Extra GUIDE Reprieve Services requirements and information surrounding the payment for such services are defined in the Participation Agreement. GUIDE Participants in the new program track that are categorized as safeguard providers will be qualified to receive a one-time facilities payment of $75,000 (geographically adjusted by the Geographic Adjustment Factor [GAF] to cover some of the upfront expenses of establishing a brand-new dementia care program.

The infrastructure payment is intended for service providers who wish to establish new dementia care programs and need resources to begin. GUIDE Individuals certified as a safeguard provider based upon the percentage of their client population that is dually qualified for Medicare and Medicaid or get the Part D low-income subsidy.

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To certify as a GUIDE safety web company, a brand-new program candidate need to have had a Medicare FFS beneficiary population comprised of a minimum of 36% beneficiaries 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 undergo recipient cost-sharing.

When a lined up recipient is re-assessed and appointed to a brand-new tier, the GUIDE Individual will be qualified to bill the G-code for the recognized client payment rate associated with that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the 2nd efficiency year will be required to repay the whole value of their facilities payment to CMS.

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After the 2nd efficiency year, GUIDE Individuals that withdraw or are terminated 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 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 design, so GUIDE Individuals will continue to costs under traditional Medicare fee-for-service for all services that are not consisted of under the DCMP. Additional information, including a complete list of duplicative codes, is readily available in the Request for Applications (Table 8, pg. 35). CMS might include or get rid of codes gradually to reflect modifications in PFS billing codes.

The care group might include the beneficiary's primary care company, and if not, the care group is required to recognize and share information with the beneficiary's main care service provider and professionals and outline the care coordination services required to handle the recipient's dementia and co-occurring conditions. CMS will supply GUIDE Participants data associated with the efficiency determines that CMS uses to figure out the GUIDE Participant's performance-based modification to the DCMP.GUIDE Individuals in the established program track ought to be prepared to begin furnishing services under the GUIDE Design on July 1, 2024, and expense for those services throughout the Model Performance Duration.

Yes, GUIDE beneficiary and supplier overlap with the Shared Savings Program is allowed. The GUIDE Design is designed to be compatible with other CMS designs and programs that aim to improve care and decrease costs. CMS thinks targeted assistance for people with dementia and their caretakers will assist enhance population-based care outcomes overall.

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As an example, if an ACO is participating in both the GUIDE Design and the Shared Savings Program during Efficiency Year 2024 and then renews and starts a new agreement 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 Standard Year 3. GUIDE Break Service claims will not be counted toward ACO expenses, shared cost savings, nor benchmarking start in 2024 for the duration of the GUIDE Design.

GUIDE Individuals might take part in numerous CMS Development Center designs or Medicare value-based care efforts to accelerate innovation in care shipment, reduce the expense of care, and enhance population health. Participants 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' total expense of care expenditures or computation of shared savings/shared losses.

Overlapping participants must follow GUIDE billing assistance as stated below. ACO REACH claim reductions will not use to DCMP. ACO REACH will consist of DCMP expenditures for functions of positioning computations. GUIDE Respite Service claims will not count towards ACO expenditures, shared savings, or benchmarking in 2025 and for the duration of the GUIDE Model.

Since January 1, 2025, GUIDE Participants also taking part in ACO REACH should stop billing the Medicare Doctor Fee Arrange Services included under the DCMP (See Exhibit 5 in the GUIDE Payment Approach Paper (PDF)). Individuals taking part in both models need to follow the GUIDE billing requirements in the GUIDE Participation Arrangement and GUIDE Payment Approach Paper.

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The GUIDE Individual need to not bill Medicare individually for the services supplied in the comprehensive assessment. The extensive evaluation (and any re-assessments) is covered by the DCMP. If CMS identifies the recipient is not qualified for the GUIDE Design, the GUIDE Individual can bill for a suitable Medicare-covered expert service that represents the services rendered.