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GUIDE Individuals have the option, and are not required, to make readily available reprieve through an adult day center or a 24-hour center. Additional GUIDE Respite Services requirements and information surrounding the payment for such services are defined in the Participation Contract. GUIDE Participants in the brand-new program track that are classified as safety net service providers will be eligible to receive a one-time infrastructure payment of $75,000 (geographically changed by the Geographic Modification Element [GAF] to cover a few of the in advance costs of establishing a new dementia care program.

The facilities payment is planned for companies who desire to establish brand-new dementia care programs and need resources to start. GUIDE Individuals certified as a safety net company based on the percentage of their client population that is dually qualified for Medicare and Medicaid or receive the Part D low-income subsidy.

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To certify as a GUIDE safeguard provider, a new program candidate need to have had a Medicare FFS beneficiary population consisted of at least 36% recipients receiving the Part D low-income subsidy 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 be subject to recipient cost-sharing.

When a lined up beneficiary is re-assessed and appointed to a new tier, the GUIDE Individual will be qualified to bill the G-code for the established client payment rate connected with that tier the following month. GUIDE Individuals that withdraw or are terminated before the start of the second performance year will be required to repay the whole worth 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 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 change fee-for-service payment for some existing Medicare Physician Cost Set Up (PFS) services, including 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 Participants will continue to bill under traditional Medicare fee-for-service for all services that are not included under the DCMP. Extra information, consisting of a complete list of duplicative codes, is available in the Demand for Applications (Table 8, pg. 35). CMS may include or get rid of codes over time to show changes in PFS billing codes.

The care team may consist of the recipient's medical care service provider, and if not, the care team is needed to recognize and share details with the recipient's main care service provider and specialists and describe the care coordination services required to handle the recipient's dementia and co-occurring conditions. CMS will supply GUIDE Participants information connected 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 ought to be prepared to begin furnishing services under the GUIDE Design on July 1, 2024, and bill for those services throughout the Design Efficiency Duration.

Yes, GUIDE recipient and service provider overlap with the Shared Savings Program is enabled. The GUIDE Design is created to be compatible with other CMS designs and programs that aim to improve care and reduce costs. CMS believes targeted assistance for individuals with dementia and their caretakers will assist improve 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 Performance Year 2024 and then restores and starts a brand-new agreement period as of January 1, 2025, that ACO would have their Shared Cost savings Program standard based on 2022, 2023 and 2024, and would have DCMPs counted in Benchmark Year 3. GUIDE Reprieve Service claims will not be counted toward ACO expenditures, shared savings, nor benchmarking beginning in 2024 for the period of the GUIDE Design.

GUIDE Individuals may take part in multiple CMS Development Center models or Medicare value-based care efforts to speed up innovation in care shipment, reduce the cost of care, and improve population health. Participants and beneficiaries are qualified to take part in the GUIDE Model and the ACO REACH Model. For the rest of CY 2024, ACO REACH will not include the Dementia Care Management Payment (DCMP) or Reprieve Service claims in the REACH ACOs' total cost of care expenses or computation of shared savings/shared losses.

Overlapping participants should follow GUIDE billing assistance as stated below. ACO REACH claim reductions will not use to DCMP. ACO REACH will include DCMP expenses for functions of alignment calculations. However, 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 also taking part in ACO REACH ought to stop billing the Medicare Doctor Cost Arrange Solutions consisted of under the DCMP (See Display 5 in the GUIDE Payment Approach Paper (PDF)). Participants taking part in both models need to follow the GUIDE billing requirements in the GUIDE Participation Arrangement and GUIDE Payment Method Paper.

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The GUIDE Individual must not bill Medicare individually for the services offered in the detailed evaluation. The extensive evaluation (and any re-assessments) is covered by the DCMP. If CMS determines the beneficiary is not eligible for the GUIDE Model, the GUIDE Participant can bill for an appropriate Medicare-covered professional service that represents the services rendered.