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GUIDE Individuals have the option, and are not needed, to make readily available respite through an adult day center or a 24-hour center. Extra GUIDE Break Services requirements and details surrounding the payment for such services are specified in the Involvement Agreement. GUIDE Participants in the new program track that are classified as safeguard companies will be qualified to get a one-time facilities payment of $75,000 (geographically adjusted by the Geographic Modification Factor [GAF] to cover some of the upfront costs of establishing a brand-new dementia care program.

The facilities payment is planned for service providers who desire to establish brand-new dementia care programs and require resources to get going. GUIDE Participants qualified as a safeguard service provider based upon the proportion of their client population that is dually qualified for Medicare and Medicaid or get the Part D low-income aid.

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To certify as a GUIDE safety web company, a new program candidate must have had a Medicare FFS recipient population comprised of at least 36% beneficiaries receiving the Part D low-income subsidy or 33.7% recipients 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 go through beneficiary cost-sharing.

When a lined up beneficiary is re-assessed and designated to a new tier, the GUIDE Individual will be eligible to bill the G-code for the established patient payment rate associated with that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the second efficiency year will be required to repay the entire worth of their facilities payment to CMS.

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After the second efficiency year, GUIDE Individuals that withdraw or are ended from the GUIDE Design are not required to repay 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, consisting of 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 bill under conventional Medicare fee-for-service for all services that are not included under the DCMP. Extra details, consisting of a total list of duplicative codes, is readily available in the Ask for Applications (Table 8, pg. 35). CMS may add or eliminate codes gradually to reflect modifications in PFS billing codes.

The care team may include the recipient's main care service provider, and if not, the care group is required to determine and share details with the beneficiary's medical care company and professionals and outline the care coordination services required to manage the recipient's dementia and co-occurring conditions. CMS will supply GUIDE Participants data associated with the performance measures that CMS utilizes to figure out the GUIDE Participant'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 Model on July 1, 2024, and expense for those services throughout the Design Efficiency Period.

Yes, GUIDE beneficiary and supplier overlap with the Shared Cost savings Program is enabled. The GUIDE Design is created to be suitable with other CMS models and programs that aim to improve care and lower costs. CMS believes targeted assistance for individuals with dementia and their caretakers will help improve population-based care results in general.

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As an example, if an ACO is getting involved in both the GUIDE Model and the Shared Savings Program throughout Performance Year 2024 and then restores and starts a new contract period 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 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 might take part in multiple CMS Innovation Center designs or Medicare value-based care initiatives to speed up development in care delivery, minimize the expense of care, and improve population health. Individuals and beneficiaries are eligible to get involved in the GUIDE Model and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not consist of the Dementia Care Management Payment (DCMP) or Reprieve Service claims in the REACH ACOs' total expense of care expenses or calculation of shared savings/shared losses.

Overlapping individuals ought to follow GUIDE billing guidance as set forth below. ACO REACH claim reductions will not apply to DCMP. ACO REACH will consist of DCMP expenditures for functions of positioning estimations. 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.

As of January 1, 2025, GUIDE Participants also taking part in ACO REACH should cease billing the Medicare Physician Fee Schedule Providers included under the DCMP (See Exhibit 5 in the GUIDE Payment Methodology Paper (PDF)). Individuals participating in both designs need to follow the GUIDE billing requirements in the GUIDE Involvement Arrangement and GUIDE Payment Approach Paper.

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The GUIDE Participant need to not bill Medicare separately for the services supplied in the thorough evaluation. The detailed assessment (and any re-assessments) is covered by the DCMP. If CMS figures out the recipient is not eligible for the GUIDE Model, the GUIDE Individual can bill for a suitable Medicare-covered professional service that corresponds to the services rendered.