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GUIDE Individuals have the alternative, and are not required, to make available respite through an adult day center or a 24-hour facility. Additional GUIDE Reprieve Services requirements and information surrounding the payment for such services are specified in the Involvement Contract.

The infrastructure payment is meant for providers who desire to develop brand-new dementia care programs and need resources to begin. GUIDE Individuals qualified as a security net supplier based upon the proportion of their patient population that is dually eligible for Medicare and Medicaid or get the Part D low-income subsidy.

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To certify as a GUIDE safeguard provider, a brand-new program applicant should have had a Medicare FFS beneficiary population made up of a minimum of 36% beneficiaries receiving the Part D low-income subsidy or 33.7% recipients 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 beneficiary cost-sharing.

When a lined up beneficiary is re-assessed and designated to a brand-new tier, the GUIDE Individual will be eligible to bill the G-code for the recognized patient payment rate connected with that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the 2nd performance year will be needed to repay the entire value of their facilities payment to CMS.

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After the second efficiency year, GUIDE Participants that withdraw or are terminated from the GUIDE Design are not required to pay back the infrastructure payment. The main model 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 Physician Charge 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 Individuals will continue to bill under standard Medicare fee-for-service for all services that are not consisted of under the DCMP. Extra information, including a total list of duplicative codes, is available in the Demand for Applications (Table 8, pg. 35). CMS might add or eliminate codes over time to show modifications in PFS billing codes.

The care team may include the recipient's primary care provider, and if not, the care group is needed to determine and share info with the beneficiary's primary care supplier and professionals and outline the care coordination services required to handle the recipient's dementia and co-occurring conditions. CMS will provide GUIDE Individuals data connected to the efficiency determines that CMS utilizes to figure out the GUIDE Individual's performance-based modification 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 costs for those services during the Design Efficiency Period.

Yes, GUIDE recipient and supplier overlap with the Shared Cost savings Program is enabled. The GUIDE Design is designed to be suitable with other CMS designs and programs that aim to improve care and minimize costs. CMS believes targeted assistance for people with dementia and their caretakers will help improve population-based care results overall.

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As an example, if an ACO is participating in both the GUIDE Design and the Shared Savings Program throughout Efficiency Year 2024 and then restores and starts a new arrangement period as of January 1, 2025, that ACO would have their Shared Savings Program standard based on 2022, 2023 and 2024, and would have DCMPs counted in Benchmark Year 3. GUIDE Break Service claims will not be counted towards ACO expenditures, shared cost savings, nor benchmarking start in 2024 for the duration of the GUIDE Design.

GUIDE Individuals may take part in several CMS Innovation Center designs or Medicare value-based care efforts to speed up innovation in care shipment, minimize the cost of care, and enhance population health. Individuals and beneficiaries are qualified to get involved 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 expense of care expenditures or estimation of shared savings/shared losses.

Overlapping participants ought to follow GUIDE billing assistance as stated below. ACO REACH claim decreases will not apply to DCMP. ACO REACH will include DCMP expenditures for functions of positioning calculations. GUIDE Respite Service claims will not count towards ACO expenditures, shared cost savings, or benchmarking in 2025 and for the duration of the GUIDE Model.

Since January 1, 2025, GUIDE Participants also taking part in ACO REACH should discontinue billing the Medicare Doctor Charge Set up Solutions included under the DCMP (See Exhibit 5 in the GUIDE Payment Approach Paper (PDF)). Individuals getting involved in both models must follow the GUIDE billing requirements in the GUIDE Participation Arrangement and GUIDE Payment Methodology Paper.

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