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GUIDE Participants have the option, and are not required, to make readily available respite through an adult day center or a 24-hour facility. Extra GUIDE Break Services requirements and information surrounding the payment for such services are defined in the Involvement Contract.

The facilities payment is planned for companies who want to develop new dementia care programs and require resources to begin. GUIDE Individuals qualified as a safeguard provider based on the percentage of their client population that is dually eligible for Medicare and Medicaid or receive the Part D low-income aid.

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To certify as a GUIDE safeguard supplier, a new program candidate need to have had a Medicare FFS recipient population made up 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 infrastructure payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE respite services will go through recipient cost-sharing.

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

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After the 2nd performance year, GUIDE Individuals that withdraw or are terminated from the GUIDE Design are not needed to repay the facilities payment. The main 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 change fee-for-service payment for some existing Medicare Doctor Charge Schedule (PFS) services, consisting of chronic care management and primary care management, transitional care management, advance care preparation, and technology-based check-ins.

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The GUIDE Model is not a total-cost-of-care design, so GUIDE Participants will continue to expense under standard Medicare fee-for-service for all services that are not consisted of under the DCMP. Additional details, including a complete list of duplicative codes, is available in the Request for Applications (Table 8, pg. 35). CMS may include or remove codes with time to show changes in PFS billing codes.

The care group may include the recipient's medical care supplier, and if not, the care group is required to recognize and share information with the recipient's primary care service provider and professionals and detail the care coordination services needed to manage the beneficiary's dementia and co-occurring conditions. CMS will provide GUIDE Participants data connected to the efficiency determines that CMS uses to identify the GUIDE Individual's performance-based modification to the DCMP.GUIDE Individuals in the recognized program track must be prepared to start furnishing services under the GUIDE Model on July 1, 2024, and expense for those services during the Model Performance Duration.

Yes, GUIDE recipient and provider overlap with the Shared Cost savings Program is allowed. The GUIDE Model is created to be compatible with other CMS designs and programs that aim to improve care and reduce costs. CMS believes targeted support for people with dementia and their caretakers will help improve population-based care results overall.

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The Dementia Care Management Payment (DCMP), the per beneficiary each month GUIDE payment, will be included in 2024 Shared Savings Program expenses. When 2024 ends up being a benchmark year, DCMPs will be consisted of in Shared Savings Program benchmark calculations. As an example, if an ACO is taking part in both the GUIDE Design and the Shared Cost Savings Program throughout Efficiency Year 2024 and after that restores and begins a new agreement period since January 1, 2025, that ACO would have their Shared Savings Program standard based upon 2022, 2023 and 2024, and would have DCMPs counted in Standard Year 3. GUIDE Break Service claims will not be counted towards ACO expenditures, shared savings, nor benchmarking start in 2024 for the duration of the GUIDE Model.

GUIDE Individuals may take part in numerous CMS Innovation Center models or Medicare value-based care initiatives to speed up innovation in care shipment, decrease the cost of care, and enhance population health. Participants and beneficiaries are qualified to take part in the GUIDE Design and the ACO REACH Model. For the rest of CY 2024, ACO REACH will not include the Dementia Care Management Payment (DCMP) or Break Service declares in the REACH ACOs' total cost of care expenditures or calculation of shared savings/shared losses.

Overlapping participants should follow GUIDE billing guidance as set forth listed below. GUIDE Reprieve Service claims will not count toward ACO expenses, shared cost savings, or benchmarking in 2025 and for the period of the GUIDE Design.

As of January 1, 2025, GUIDE Individuals also taking part in ACO REACH need to stop billing the Medicare Physician Charge Set up Services consisted of under the DCMP (See Exhibition 5 in the GUIDE Payment Methodology Paper (PDF)). Individuals taking part in both designs must follow the GUIDE billing requirements in the GUIDE Participation Agreement and GUIDE Payment Approach Paper.

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The GUIDE Participant should not bill Medicare individually for the services provided in the detailed assessment. The thorough evaluation (and any re-assessments) is covered by the DCMP. If CMS determines the beneficiary is not qualified for the GUIDE Design, the GUIDE Participant can bill for a suitable Medicare-covered expert service that corresponds to the services rendered.