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GUIDE Participants have the option, and are not required, to make readily available reprieve through an adult day center or a 24-hour center. Extra GUIDE Reprieve Solutions requirements and information surrounding the payment for such services are defined in the Participation Agreement.

The infrastructure payment is meant for companies who want to develop new dementia care programs and require resources to start. GUIDE Individuals certified as a security net service provider based on the proportion of their patient 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 safeguard provider, a new program candidate need to have had a Medicare FFS beneficiary population consisted of at least 36% beneficiaries receiving the Part D low-income aid or 33.7% beneficiaries who are dually eligible for Medicare and Medicaid. Accepting the facilities payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE reprieve services will go through recipient cost-sharing.

When an aligned recipient is re-assessed and assigned to a new tier, the GUIDE Individual will be qualified to bill the G-code for the established patient 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 value 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 infrastructure payment. The primary 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 Physician Fee Set Up (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 Design is not a total-cost-of-care design, so GUIDE Participants will continue to costs under standard Medicare fee-for-service for all services that are not included under the DCMP. CMS may add or remove codes over time to reflect modifications in PFS billing codes.

The care team might include the beneficiary's primary care provider, and if not, the care group is required to determine and share info with the beneficiary's main care provider and specialists and outline the care coordination services required to handle the recipient's dementia and co-occurring conditions. CMS will offer GUIDE Participants data connected to the efficiency measures that CMS uses to figure out the GUIDE Participant's performance-based modification to the DCMP.GUIDE Individuals in the established program track need to be prepared to begin providing services under the GUIDE Design on July 1, 2024, and costs for those services throughout the Model Performance Period.

Yes, GUIDE recipient and service provider overlap with the Shared Savings Program is allowed. The GUIDE Design is created to be compatible with other CMS designs and programs that aim to improve care and lower costs. CMS believes targeted assistance for people with dementia and their caregivers will help improve population-based care results overall.

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The Dementia Care Management Payment (DCMP), the per beneficiary per month GUIDE payment, will be consisted of in 2024 Shared Cost savings Program expenditures. When 2024 ends up being a benchmark year, DCMPs will be included in Shared Savings Program benchmark estimations. As an example, if an ACO is taking part in both the GUIDE Design and the Shared Cost Savings Program throughout Performance Year 2024 and after that renews and starts a brand-new arrangement 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 Criteria Year 3. However, GUIDE Break Service claims will not be counted towards ACO expenses, shared cost savings, nor benchmarking start in 2024 for the duration of the GUIDE Design.

GUIDE Participants might take part in multiple CMS Innovation Center models or Medicare value-based care efforts to accelerate development in care shipment, decrease the cost of care, and enhance population health. Participants 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 expenditures or computation of shared savings/shared losses.

Overlapping participants need to follow GUIDE billing guidance as stated listed below. ACO REACH claim reductions will not apply to DCMP. ACO REACH will include DCMP expenditures for functions of alignment calculations. Nevertheless, GUIDE Reprieve Service claims will not count towards ACO expenditures, shared savings, or benchmarking in 2025 and for the duration of the GUIDE Model.

Since January 1, 2025, GUIDE Individuals likewise taking part in ACO REACH need to stop billing the Medicare Physician Fee Schedule Services included under the DCMP (See Exhibit 5 in the GUIDE Payment Methodology Paper (PDF)). Individuals taking part in both designs should follow the GUIDE billing requirements in the GUIDE Participation Arrangement and GUIDE Payment Approach Paper.

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The GUIDE Individual need to not bill Medicare individually for the services offered in the comprehensive assessment. The thorough evaluation (and any re-assessments) is covered by the DCMP. If CMS figures out the beneficiary is not eligible for the GUIDE Design, the GUIDE Participant can bill for a suitable Medicare-covered expert service that represents the services rendered.