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GUIDE Individuals have the alternative, and are not needed, to make available reprieve through an adult day center or a 24-hour facility. Additional GUIDE Break Solutions requirements and details surrounding the payment for such services are defined in the Involvement Agreement. GUIDE Participants in the new program track that are categorized as safeguard companies will be qualified to get a one-time facilities payment of $75,000 (geographically adjusted by the Geographic Modification Aspect [GAF] to cover some of the in advance expenses of establishing a new dementia care program.

The facilities payment is intended for suppliers who want to establish brand-new dementia care programs and require resources to start. GUIDE Participants certified as a safeguard provider 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 qualify as a GUIDE safeguard company, a new program candidate must have had a Medicare FFS beneficiary population made up of a minimum of 36% beneficiaries getting the Part D low-income subsidy or 33.7% beneficiaries who are dually qualified for Medicare and Medicaid. Accepting the facilities payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE respite 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 recognized patient payment rate associated with that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the second performance year will be required to repay the entire worth of their facilities payment to CMS.

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After the 2nd efficiency year, GUIDE Individuals that withdraw or are ended from the GUIDE Design are not needed to pay back the infrastructure payment. The primary 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 Doctor Charge Set Up (PFS) services, consisting of chronic 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 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. Extra information, including a complete list of duplicative codes, is available in the Demand for Applications (Table 8, pg. 35). CMS may add or eliminate codes gradually to show modifications in PFS billing codes.

The care group may include the recipient's main care supplier, and if not, the care group is required to determine and share information with the beneficiary's primary care provider and professionals and lay out the care coordination services needed to manage the beneficiary's dementia and co-occurring conditions. CMS will offer GUIDE Individuals data associated with the performance measures that CMS utilizes to identify the GUIDE Participant's performance-based change to the DCMP.GUIDE Participants in the established program track need to be prepared to begin providing services under the GUIDE Model on July 1, 2024, and expense for those services during the Design Performance Duration.

Yes, GUIDE recipient and provider overlap with the Shared Savings Program is permitted. The GUIDE Design is designed to be compatible with other CMS models and programs that intend to enhance care and lower costs. CMS believes targeted support for individuals with dementia and their caregivers will assist improve population-based care outcomes in general.

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As an example, if an ACO is getting involved in both the GUIDE Model and the Shared Cost Savings Program during Efficiency Year 2024 and then renews and begins a brand-new contract period as of January 1, 2025, that ACO would have their Shared Savings Program criteria 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 expenses, shared savings, nor benchmarking beginning in 2024 for the period of the GUIDE Design.

GUIDE Participants might take part in numerous CMS Innovation Center designs or Medicare value-based care initiatives to speed up development in care shipment, minimize the cost of care, and improve population health. Individuals 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 include the Dementia Care Management Payment (DCMP) or Respite Service claims in the REACH ACOs' total expense of care expenditures or estimation of shared savings/shared losses.

Overlapping participants ought to follow GUIDE billing assistance as set forth listed below. GUIDE Respite Service claims will not count toward ACO expenses, shared cost savings, or benchmarking in 2025 and for the duration of the GUIDE Model.

As of January 1, 2025, GUIDE Participants likewise taking part in ACO REACH must stop billing the Medicare Doctor Cost Schedule Services included under the DCMP (See Display 5 in the GUIDE Payment Method Paper (PDF)). Individuals participating 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 Participant must not bill Medicare separately for the services offered in the thorough evaluation. The comprehensive evaluation (and any re-assessments) is covered by the DCMP. If CMS identifies the beneficiary is not eligible for the GUIDE Model, the GUIDE Participant can bill for an appropriate Medicare-covered expert service that corresponds to the services rendered.