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GUIDE Participants have the choice, and are not required, to make available respite through an adult day center or a 24-hour facility. Extra GUIDE Respite Services requirements and information surrounding the payment for such services are specified in the Participation Contract.

The infrastructure payment is intended for providers who wish to develop new dementia care programs and need resources to get begun. GUIDE Participants certified as a safety net service provider based on the percentage of their patient population that is dually qualified for Medicare and Medicaid or get the Part D low-income aid.

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To qualify as a GUIDE safety web provider, a brand-new program candidate must have had a Medicare FFS beneficiary population consisted of at least 36% beneficiaries getting the Part D low-income subsidy or 33.7% recipients who are dually eligible 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 an aligned recipient is re-assessed and assigned to a new tier, the GUIDE Individual will be eligible to bill the G-code for the established client payment rate related to that tier the following month. GUIDE Individuals that withdraw or are terminated before the start of the 2nd efficiency year will be needed to pay back the whole value of their facilities payment to CMS.

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After the 2nd efficiency year, GUIDE Individuals that withdraw or are terminated from the GUIDE Design are not needed to pay back the infrastructure payment. The primary 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 Fee Set Up (PFS) services, consisting of persistent care management and principal 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 expense under standard Medicare fee-for-service for all services that are not included under the DCMP. CMS might include or eliminate codes over time to reflect changes in PFS billing codes.

The care group may consist of the recipient's medical care company, and if not, the care team is required to identify and share details with the beneficiary's medical care provider and professionals and lay out the care coordination services needed to manage the beneficiary's dementia and co-occurring conditions. CMS will supply GUIDE Individuals information associated with the performance determines that CMS uses to determine the GUIDE Participant's performance-based change to the DCMP.GUIDE Individuals in the recognized program track ought to be prepared to begin furnishing services under the GUIDE Model on July 1, 2024, and expense for those services throughout the Design Performance Duration.

Yes, GUIDE beneficiary and service provider overlap with the Shared Savings Program is permitted. The GUIDE Design is created to be suitable with other CMS designs and programs that intend to improve care and reduce spending. CMS believes targeted assistance for individuals with dementia and their caregivers will assist improve population-based care outcomes in general.

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The Dementia Care Management Payment (DCMP), the per beneficiary monthly GUIDE payment, will be included in 2024 Shared Savings Program expenses. When 2024 ends up being a benchmark year, DCMPs will be included in Shared Savings Program standard calculations. As an example, if an ACO is participating in both the GUIDE Model and the Shared Cost Savings Program during Efficiency Year 2024 and after that restores and begins a brand-new arrangement 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 Standard Year 3. GUIDE Reprieve Service claims will not be counted toward ACO expenditures, shared savings, nor benchmarking beginning in 2024 for the duration of the GUIDE Model.

GUIDE Participants may take part in numerous CMS Innovation Center models or Medicare value-based care efforts to accelerate innovation in care delivery, decrease the cost of care, and enhance population health. Individuals and beneficiaries are eligible to take part in the GUIDE Design and the ACO REACH Design. 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' overall expense of care expenditures or computation of shared savings/shared losses.

Overlapping individuals should follow GUIDE billing assistance as set forth listed below. ACO REACH claim reductions will not use to DCMP. ACO REACH will consist of DCMP expenditures for functions of positioning estimations. GUIDE Respite 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 Individuals likewise participating in ACO REACH must cease billing the Medicare Physician Charge Set up Providers included under the DCMP (See Exhibit 5 in the GUIDE Payment Approach Paper (PDF)). Individuals getting involved in both models should follow the GUIDE billing requirements in the GUIDE Participation Contract and GUIDE Payment Methodology Paper.

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The GUIDE Individual need to not bill Medicare independently for the services provided in the extensive evaluation. The extensive assessment (and any re-assessments) is covered by the DCMP. If CMS identifies the beneficiary is not eligible for the GUIDE Model, the GUIDE Participant can bill for a proper Medicare-covered professional service that corresponds to the services rendered.