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GUIDE Participants have the option, and are not needed, to make readily available reprieve through an adult day center or a 24-hour facility. Additional GUIDE Respite Solutions requirements and information surrounding the payment for such services are specified in the Involvement Contract.

The infrastructure payment is intended for service providers who want to establish brand-new dementia care programs and require resources to get going. GUIDE Individuals certified as a security net company based upon the percentage of their client population that is dually eligible for Medicare and Medicaid or receive the Part D low-income subsidy.

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To qualify as a GUIDE safety net service provider, a brand-new program candidate must have had a Medicare FFS recipient population made up of a minimum of 36% recipients receiving the Part D low-income subsidy or 33.7% recipients who are dually qualified for Medicare and Medicaid. Accepting the facilities 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 appointed to a new tier, the GUIDE Participant will be eligible to bill the G-code for the established patient payment rate related to that tier the following month. GUIDE Individuals that withdraw or are terminated before the start of the 2nd performance year will be required to repay the whole worth of their infrastructure payment to CMS.

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After the second efficiency year, GUIDE Participants that withdraw or are ended from the GUIDE Model are not required to repay the infrastructure 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 change fee-for-service payment for some existing Medicare Doctor Cost Schedule (PFS) services, including 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 design, so GUIDE Individuals will continue to expense under conventional Medicare fee-for-service for all services that are not included under the DCMP. CMS may add or get rid of codes over time to reflect modifications 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 identify and share info with the beneficiary's medical care provider and specialists and outline the care coordination services required to manage the beneficiary's dementia and co-occurring conditions. CMS will offer GUIDE Participants data connected to the performance measures that CMS utilizes to identify the GUIDE Participant's performance-based modification to the DCMP.GUIDE Participants in the established program track should be prepared to start furnishing services under the GUIDE Model on July 1, 2024, and expense for those services during the Model Efficiency Period.

Yes, GUIDE recipient and provider overlap with the Shared Cost savings Program is permitted. The GUIDE Design is created to be compatible with other CMS models and programs that aim to improve care and minimize spending. CMS thinks targeted support for people with dementia and their caregivers will assist enhance population-based care results in general.

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As an example, if an ACO is taking part in both the GUIDE Model and the Shared Cost Savings Program during Efficiency Year 2024 and then restores and begins 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 Benchmark Year 3. GUIDE Respite Service claims will not be counted toward ACO expenditures, shared savings, nor benchmarking beginning in 2024 for the period of the GUIDE Design.

GUIDE Individuals may take part in several CMS Innovation Center designs or Medicare value-based care initiatives to speed up development in care shipment, reduce the expense of care, and improve population health. Individuals and recipients are eligible to take part in the GUIDE Model and the ACO REACH Design. 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' overall expense of care expenditures or estimation of shared savings/shared losses.

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

As of January 1, 2025, GUIDE Individuals likewise taking part in ACO REACH must discontinue billing the Medicare Doctor Charge Schedule Providers consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Methodology Paper (PDF)). Participants participating in both designs need to follow the GUIDE billing requirements in the GUIDE Involvement Arrangement and GUIDE Payment Method Paper.

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