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GUIDE Participants have the alternative, and are not required, to make available reprieve through an adult day center or a 24-hour facility. Additional GUIDE Reprieve Services requirements and information surrounding the payment for such services are defined in the Involvement Agreement. GUIDE Participants in the brand-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 Modification Aspect [GAF] to cover a few of the upfront costs of developing a brand-new dementia care program.

The infrastructure payment is intended for providers who desire to establish brand-new dementia care programs and need resources to start. GUIDE Individuals certified as a safeguard service provider based on the percentage of their patient population that is dually qualified for Medicare and Medicaid or receive the Part D low-income subsidy.

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To certify as a GUIDE safety net provider, a brand-new program candidate should have had a Medicare FFS beneficiary population made up of a minimum of 36% recipients receiving 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 respite services will undergo beneficiary cost-sharing.

When an aligned recipient is re-assessed and appointed to a brand-new tier, the GUIDE Individual will be qualified to bill the G-code for the established client 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 required to pay back the whole worth of their infrastructure payment to CMS.

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After the 2nd performance year, GUIDE Participants that withdraw or are ended from the GUIDE Design are not needed to repay the facilities payment. The primary 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 Charge Arrange (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 Design is not a total-cost-of-care design, so GUIDE Individuals 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 show modifications in PFS billing codes.

The care group may include the recipient's primary care service provider, and if not, the care team is needed to recognize and share info with the recipient's main care service provider and experts and lay out the care coordination services needed to handle the recipient's dementia and co-occurring conditions. CMS will supply GUIDE Participants data related to the efficiency determines that CMS utilizes to determine the GUIDE Participant's performance-based adjustment to the DCMP.GUIDE Individuals in the recognized program track must be prepared to start providing services under the GUIDE Design on July 1, 2024, and bill for those services during the Design Efficiency Duration.

Yes, GUIDE beneficiary and service provider overlap with the Shared Cost savings Program is permitted. The GUIDE Model is developed to be compatible with other CMS models and programs that intend to improve care and decrease spending. CMS believes targeted assistance for individuals with dementia and their caretakers will help enhance population-based care outcomes overall.

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The Dementia Care Management Payment (DCMP), the per beneficiary each month GUIDE payment, will be consisted of in 2024 Shared Savings Program expenses. When 2024 becomes a benchmark year, DCMPs will be included in Shared Savings Program standard 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 brand-new agreement period as of 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 Reprieve Service claims will not be counted toward ACO expenditures, shared savings, nor benchmarking start in 2024 for the period of the GUIDE Design.

GUIDE Participants may take part in several CMS Innovation Center designs or Medicare value-based care efforts to accelerate innovation in care delivery, lower the expense of care, and enhance population health. Individuals and recipients are eligible to participate 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 Respite Service claims in the REACH ACOs' total cost of care expenses or calculation of shared savings/shared losses.

Overlapping individuals ought to follow GUIDE billing guidance as set forth below. GUIDE Respite Service claims will not count toward ACO expenses, shared savings, or benchmarking in 2025 and for the duration of the GUIDE Design.

Since January 1, 2025, GUIDE Participants likewise participating in ACO REACH need to cease billing the Medicare Doctor Charge Set up Services consisted of under the DCMP (See Exhibition 5 in the GUIDE Payment Method Paper (PDF)). Individuals taking part in both models should 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 separately for the services provided in the comprehensive assessment. The thorough evaluation (and any re-assessments) is covered by the DCMP. If CMS identifies the recipient is not qualified for the GUIDE Model, the GUIDE Participant can bill for a suitable Medicare-covered professional service that corresponds to the services rendered.