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Nevertheless, GUIDE Individuals have the choice, and are not required, to provide reprieve through an adult day center or a 24-hour center. Additional GUIDE Reprieve Solutions requirements and details surrounding the payment for such services are defined in the Involvement Contract. GUIDE Individuals in the new program track that are classified as safeguard service providers will be eligible to get a one-time facilities payment of $75,000 (geographically changed by the Geographic Adjustment Aspect [GAF] to cover some of the upfront expenses of developing a new dementia care program.

The facilities payment is intended for service providers who wish to establish new dementia care programs and need resources to start. GUIDE Individuals certified as a safeguard company based on the proportion of their client population that is dually eligible for Medicare and Medicaid or get the Part D low-income subsidy.

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To qualify as a GUIDE security web provider, a brand-new program candidate must have had a Medicare FFS recipient population consisted of at least 36% recipients getting the Part D low-income aid or 33.7% recipients who are dually qualified for Medicare and Medicaid. Accepting the infrastructure payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE reprieve services will undergo beneficiary cost-sharing.

When an aligned beneficiary is re-assessed and designated to a brand-new tier, the GUIDE Participant will be qualified to bill the G-code for the recognized client payment rate associated with that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the 2nd efficiency year will be required to pay back the whole value of their infrastructure payment to CMS.

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After the second performance year, GUIDE Participants that withdraw or are terminated from the GUIDE Model are not needed 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 Doctor Cost Set Up (PFS) services, including persistent care management and primary care management, transitional care management, advance care planning, and technology-based check-ins.

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The GUIDE Model is not a total-cost-of-care model, so GUIDE Participants will continue to bill under conventional Medicare fee-for-service for all services that are not included under the DCMP. CMS may include or remove codes over time to reflect modifications in PFS billing codes.

The care group may include the beneficiary's medical care service provider, and if not, the care group is needed to recognize and share details with the beneficiary's medical care company and experts and lay out the care coordination services required to handle the recipient's dementia and co-occurring conditions. CMS will provide GUIDE Participants information connected to the performance measures that CMS uses to identify the GUIDE Participant's performance-based change to the DCMP.GUIDE Participants in the recognized program track ought to be prepared to start providing services under the GUIDE Design on July 1, 2024, and costs for those services during the Model Efficiency Duration.

Yes, GUIDE beneficiary and company overlap with the Shared Savings Program is allowed. The GUIDE Design is created to be suitable with other CMS designs and programs that intend to improve care and lower costs. CMS thinks targeted support for individuals with dementia and their caregivers will help enhance population-based care outcomes overall.

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As an example, if an ACO is getting involved in both the GUIDE Design and the Shared Savings Program throughout Efficiency Year 2024 and then renews and starts a new agreement duration as of January 1, 2025, that ACO would have their Shared Cost savings Program criteria based on 2022, 2023 and 2024, and would have DCMPs counted in Benchmark Year 3. GUIDE Reprieve Service claims will not be counted towards ACO expenditures, shared cost savings, nor benchmarking beginning in 2024 for the period of the GUIDE Model.

GUIDE Individuals may take part in multiple CMS Development Center designs or Medicare value-based care initiatives to speed up development in care delivery, decrease the expense of care, and enhance population health. Individuals and recipients are eligible to take part in the GUIDE Design 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 declares in the REACH ACOs' total cost of care expenses or estimation of shared savings/shared losses.

Overlapping participants need to follow GUIDE billing assistance as set forth below. ACO REACH claim decreases will not use to DCMP. ACO REACH will include DCMP expenses for purposes of alignment calculations. GUIDE Break Service claims will not count toward ACO expenditures, shared savings, or benchmarking in 2025 and for the period of the GUIDE Model.

Since January 1, 2025, GUIDE Participants also taking part in ACO REACH need to cease billing the Medicare Physician Cost Schedule Services 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 Contract and GUIDE Payment Method Paper.

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The GUIDE Participant must not bill Medicare independently for the services offered in the detailed evaluation. The detailed assessment (and any re-assessments) is covered by the DCMP. If CMS determines the beneficiary is not qualified for the GUIDE Design, the GUIDE Individual can bill for an appropriate Medicare-covered professional service that represents the services rendered.