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Nevertheless, GUIDE Participants have the alternative, and are not needed, to provide break through an adult day center or a 24-hour facility. Extra GUIDE Respite Providers requirements and details surrounding the payment for such services are defined in the Participation Agreement. GUIDE Individuals in the new program track that are classified as safety net providers will be qualified to get a one-time facilities payment of $75,000 (geographically adjusted by the Geographic Change Factor [GAF] to cover a few of the in advance expenses of developing a brand-new dementia care program.

The infrastructure payment is meant for providers who wish to develop brand-new dementia care programs and need resources to start. GUIDE Participants certified as a security net provider based upon the percentage of their client population that is dually eligible for Medicare and Medicaid or get the Part D low-income aid.

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To certify as a GUIDE safety net provider, a new program candidate must have had a Medicare FFS recipient population consisted of a minimum of 36% recipients receiving 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 respite services will be subject to beneficiary cost-sharing.

When a lined up recipient is re-assessed and designated to a brand-new tier, the GUIDE Participant will be eligible to bill the G-code for the recognized client payment rate connected with that tier the following month. GUIDE Individuals that withdraw or are terminated before the start of the second performance year will be required to pay back the whole worth of their facilities payment to CMS.

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After the 2nd performance year, GUIDE Participants that withdraw or are terminated from the GUIDE Design are not needed to pay back the infrastructure payment. The main 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 Physician Charge Set Up (PFS) services, including chronic 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 Participants will continue to bill under conventional Medicare fee-for-service for all services that are not consisted of under the DCMP. Additional information, including a total list of duplicative codes, is offered in the Request for Applications (Table 8, pg. 35). CMS might add or remove codes gradually to reflect changes in PFS billing codes.

The care team might consist of the beneficiary's medical care company, and if not, the care team is needed to determine and share information with the beneficiary's primary care supplier and experts and describe the care coordination services required to manage the recipient's dementia and co-occurring conditions. CMS will provide GUIDE Participants data connected to the performance measures that CMS utilizes to determine the GUIDE Individual's performance-based adjustment to the DCMP.GUIDE Individuals in the recognized program track should be prepared to start furnishing services under the GUIDE Design on July 1, 2024, and expense for those services during the Design Efficiency Period.

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

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As an example, if an ACO is getting involved in both the GUIDE Model and the Shared Cost Savings Program throughout Efficiency Year 2024 and then restores and begins a brand-new contract period as of January 1, 2025, that ACO would have their Shared Savings Program criteria based on 2022, 2023 and 2024, and would have DCMPs counted in Criteria Year 3. GUIDE Break Service claims will not be counted toward ACO expenses, shared savings, nor benchmarking start in 2024 for the period of the GUIDE Design.

GUIDE Individuals may take part in several CMS Development Center designs or Medicare value-based care initiatives to accelerate innovation in care shipment, minimize the cost of care, and enhance population health. Individuals and beneficiaries are eligible 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 Respite Service claims in the REACH ACOs' total cost of care expenses or computation of shared savings/shared losses.

Overlapping participants ought to follow GUIDE billing assistance as set forth listed below. ACO REACH claim reductions will not apply to DCMP. ACO REACH will consist of DCMP expenditures for functions of alignment computations. However, GUIDE Reprieve Service claims will not count towards ACO expenditures, shared savings, or benchmarking in 2025 and throughout of the GUIDE Model.

As of January 1, 2025, GUIDE Individuals likewise taking part in ACO REACH need to discontinue billing the Medicare Physician Cost Arrange Solutions consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Methodology Paper (PDF)). Individuals taking part in both models need to follow the GUIDE billing requirements in the GUIDE Involvement Contract and GUIDE Payment Approach Paper.

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The GUIDE Participant should not bill Medicare separately for the services offered in the extensive evaluation. The detailed assessment (and any re-assessments) is covered by the DCMP. If CMS figures out the recipient is not qualified for the GUIDE Model, the GUIDE Individual can bill for a suitable Medicare-covered expert service that represents the services rendered.