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Nevertheless, GUIDE Participants have the alternative, and are not required, to offer reprieve through an adult day center or a 24-hour center. Extra GUIDE Respite Services requirements and details surrounding the payment for such services are defined in the Participation Agreement. GUIDE Participants in the new program track that are classified as safeguard suppliers will be eligible to get a one-time infrastructure payment of $75,000 (geographically adjusted by the Geographic Modification Factor [GAF] to cover a few of the upfront costs of developing a brand-new dementia care program.

The facilities payment is intended for providers who wish to establish brand-new dementia care programs and need resources to get going. GUIDE Individuals certified as a security net supplier 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 certify as a GUIDE security internet company, a new program applicant must have had a Medicare FFS recipient population consisted of at least 36% beneficiaries getting the Part D low-income aid or 33.7% beneficiaries who are dually qualified for Medicare and Medicaid. Accepting the infrastructure payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE break services will be subject to beneficiary 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 related to that tier the following month. GUIDE Individuals that withdraw or are ended before the start of the 2nd performance year will be required to pay back the entire value of their infrastructure payment to CMS.

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After the 2nd performance year, GUIDE Individuals that withdraw or are ended from the GUIDE Model are not needed to pay back the facilities payment. The main 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 Cost Schedule (PFS) services, including persistent 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 Individuals will continue to expense under conventional Medicare fee-for-service for all services that are not included under the DCMP. CMS might add or remove codes over time to show changes in PFS billing codes.

The care team might include the recipient's medical care company, and if not, the care team is required to recognize and share info with the recipient's main care provider and specialists and lay out the care coordination services required to handle the recipient's dementia and co-occurring conditions. CMS will supply GUIDE Participants data connected to the efficiency measures that CMS uses to identify the GUIDE Participant's performance-based change to the DCMP.GUIDE Individuals in the established program track should be prepared to start furnishing services under the GUIDE Design on July 1, 2024, and costs for those services during the Design Efficiency Duration.

Yes, GUIDE beneficiary and company overlap with the Shared Cost savings Program is enabled. The GUIDE Design is designed to be suitable with other CMS models and programs that aim to enhance care and lower costs. CMS believes targeted assistance for people with dementia and their caretakers will assist improve population-based care outcomes in general.

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The Dementia Care Management Payment (DCMP), the per recipient per month GUIDE payment, will be consisted of in 2024 Shared Cost savings Program expenditures. When 2024 becomes a benchmark year, DCMPs will be included in Shared Cost savings Program benchmark computations. As an example, if an ACO is taking part in both the GUIDE Design and the Shared Savings Program during Efficiency Year 2024 and then renews and begins a new arrangement duration as of January 1, 2025, that ACO would have their Shared Savings Program criteria based upon 2022, 2023 and 2024, and would have DCMPs counted in Benchmark Year 3. GUIDE Reprieve Service claims will not be counted towards ACO expenses, shared savings, nor benchmarking start in 2024 for the duration of the GUIDE Design.

GUIDE Individuals may get involved in several CMS Innovation Center models or Medicare value-based care efforts to speed up innovation in care shipment, reduce the expense of care, and enhance population health. Individuals and beneficiaries are qualified to take part in the GUIDE Model and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not consist of the Dementia Care Management Payment (DCMP) or Reprieve Service claims in the REACH ACOs' overall expense of care expenditures or calculation of shared savings/shared losses.

Overlapping individuals need to follow GUIDE billing assistance as set forth listed below. GUIDE Respite Service claims will not count toward ACO expenditures, shared savings, or benchmarking in 2025 and for the period of the GUIDE Design.

As of January 1, 2025, GUIDE Participants likewise taking part in ACO REACH should discontinue billing the Medicare Physician Cost Set up Providers included under the DCMP (See Display 5 in the GUIDE Payment Methodology Paper (PDF)). Individuals taking part in both designs must follow the GUIDE billing requirements in the GUIDE Involvement Agreement and GUIDE Payment Approach Paper.

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The GUIDE Participant must not bill Medicare separately for the services provided in the extensive evaluation. The extensive assessment (and any re-assessments) is covered by the DCMP. If CMS identifies the recipient is not eligible for the GUIDE Model, the GUIDE Participant can bill for an appropriate Medicare-covered expert service that represents the services rendered.