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GUIDE Participants have the alternative, and are not needed, to make available break through an adult day center or a 24-hour facility. Extra GUIDE Reprieve Services requirements and information surrounding the payment for such services are specified in the Participation Contract.

The facilities payment is intended for providers who want to establish brand-new dementia care programs and need resources to start. GUIDE Participants qualified as a safety net service provider based on the percentage of their patient 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 safeguard supplier, a brand-new program applicant need to have had a Medicare FFS beneficiary population consisted of a minimum of 36% recipients getting the Part D low-income subsidy or 33.7% beneficiaries who are dually eligible for Medicare and Medicaid. Accepting the infrastructure payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE reprieve services will undergo recipient cost-sharing.

When a lined up 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 associated with that tier the following month. GUIDE Individuals that withdraw or are ended before the start of the second efficiency year will be required to pay back the whole value of their facilities payment to CMS.

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After the second performance year, GUIDE Individuals that withdraw or are ended from the GUIDE Model are not required to pay back the facilities payment. The primary 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 replace fee-for-service payment for some existing Medicare Physician Cost Arrange (PFS) services, including persistent care management and principal 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 model, so GUIDE Participants will continue to costs under standard Medicare fee-for-service for all services that are not consisted of under the DCMP. CMS may add or get rid of codes over time to reflect changes in PFS billing codes.

The care group may consist of the beneficiary's main care company, and if not, the care team is required to determine and share details with the beneficiary's medical care supplier and professionals and detail the care coordination services required to handle the beneficiary's dementia and co-occurring conditions. CMS will supply GUIDE Participants information related to the performance measures that CMS utilizes to identify the GUIDE Individual's performance-based adjustment to the DCMP.GUIDE Individuals in the established program track must be prepared to start providing services under the GUIDE Model on July 1, 2024, and expense for those services during the Model Performance Duration.

Yes, GUIDE beneficiary and supplier overlap with the Shared Cost savings Program is permitted. The GUIDE Design is designed to be suitable with other CMS designs and programs that intend to improve care and lower costs. CMS thinks targeted support for people with dementia and their caretakers will help improve population-based care results in general.

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The Dementia Care Management Payment (DCMP), the per recipient each month GUIDE payment, will be consisted of in 2024 Shared Cost savings Program expenses. When 2024 ends up being a benchmark year, DCMPs will be included in Shared Cost savings Program criteria estimations. As an example, if an ACO is taking part in both the GUIDE Design and the Shared Cost Savings Program during Performance Year 2024 and after that restores and starts a new contract duration since January 1, 2025, that ACO would have their Shared Cost savings Program standard based upon 2022, 2023 and 2024, and would have DCMPs counted in Benchmark Year 3. Nevertheless, GUIDE Reprieve Service claims will not be counted toward ACO expenses, shared cost savings, nor benchmarking beginning in 2024 for the period of the GUIDE Model.

GUIDE Individuals may take part in multiple CMS Development Center models or Medicare value-based care efforts to accelerate innovation in care delivery, lower the expense of care, and enhance population health. Participants and recipients are eligible to participate in the GUIDE Design and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not include the Dementia Care Management Payment (DCMP) or Reprieve Service declares in the REACH ACOs' overall cost of care expenditures or calculation of shared savings/shared losses.

Overlapping individuals must follow GUIDE billing assistance as set forth below. GUIDE Respite Service claims will not count towards ACO expenses, shared savings, or benchmarking in 2025 and for the duration of the GUIDE Design.

As of January 1, 2025, GUIDE Individuals likewise taking part in ACO REACH must discontinue billing the Medicare Physician Charge Arrange Providers included under the DCMP (See Display 5 in the GUIDE Payment Method Paper (PDF)). Participants taking part in both designs need to follow the GUIDE billing requirements in the GUIDE Involvement Contract and GUIDE Payment Methodology Paper.

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The GUIDE Individual must not bill Medicare separately for the services offered in the detailed evaluation. The thorough assessment (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 expert service that represents the services rendered.