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Nevertheless, GUIDE Individuals have the option, and are not required, to provide reprieve through an adult day center or a 24-hour center. Additional GUIDE Break Solutions requirements and information surrounding the payment for such services are defined in the Involvement Arrangement. GUIDE Participants in the brand-new program track that are classified as security net providers will be eligible to receive a one-time infrastructure payment of $75,000 (geographically changed by the Geographic Change Aspect [GAF] to cover a few of the upfront costs of establishing a new dementia care program.

The facilities payment is meant for service providers who wish to establish brand-new dementia care programs and require resources to get going. GUIDE Individuals qualified as a safeguard supplier based on the proportion 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 security internet provider, a new program applicant must have had a Medicare FFS beneficiary population comprised of at least 36% beneficiaries receiving the Part D low-income subsidy or 33.7% beneficiaries who are dually eligible for Medicare and Medicaid. Accepting the infrastructure payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE reprieve services will undergo recipient cost-sharing.

When a lined up recipient is re-assessed and designated to a new tier, the GUIDE Participant will be eligible to bill the G-code for the recognized client payment rate related to that tier the following month. GUIDE Individuals that withdraw or are ended before the start of the 2nd performance year will be required to pay back the entire 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 Model are not required to repay the facilities 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 replace fee-for-service payment for some existing Medicare Doctor Fee Set Up (PFS) services, including chronic care management and principal 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 model, so GUIDE Participants will continue to costs under traditional Medicare fee-for-service for all services that are not included under the DCMP. CMS may add or remove codes over time to show modifications in PFS billing codes.

The care group might include the beneficiary's medical care provider, and if not, the care group is needed to identify and share info with the recipient's main care supplier and specialists and lay out the care coordination services required to manage the beneficiary's dementia and co-occurring conditions. CMS will provide GUIDE Individuals data connected to the efficiency measures that CMS utilizes to figure out the GUIDE Individual's performance-based change to the DCMP.GUIDE Individuals in the established program track need to be prepared to begin furnishing services under the GUIDE Model on July 1, 2024, and expense for those services throughout the Design Performance Period.

Yes, GUIDE recipient and service provider overlap with the Shared Savings Program is allowed. The GUIDE Design is developed to be suitable with other CMS models and programs that intend to enhance care and minimize costs. CMS thinks targeted assistance for individuals with dementia and their caregivers will help enhance population-based care results overall.

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As an example, if an ACO is getting involved in both the GUIDE Design and the Shared Cost Savings Program throughout Performance Year 2024 and then restores and begins a 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. GUIDE Respite Service claims will not be counted towards ACO expenses, shared cost savings, nor benchmarking start in 2024 for the period of the GUIDE Model.

GUIDE Participants may take part in several CMS Development Center designs or Medicare value-based care initiatives to speed up development in care shipment, decrease the cost of care, and improve 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 consist of the Dementia Care Management Payment (DCMP) or Reprieve Service claims in the REACH ACOs' overall expense of care expenses or estimation of shared savings/shared losses.

Overlapping individuals must follow GUIDE billing guidance as set forth below. ACO REACH claim decreases will not apply to DCMP. ACO REACH will include DCMP expenditures for functions of alignment calculations. GUIDE Reprieve Service claims will not count toward ACO expenditures, shared cost savings, or benchmarking in 2025 and for the period of the GUIDE Design.

As of January 1, 2025, GUIDE Participants also participating in ACO REACH ought to terminate billing the Medicare Doctor Fee Arrange Services consisted of under the DCMP (See Exhibition 5 in the GUIDE Payment Method Paper (PDF)). Participants getting involved in both models need to 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 supplied in the detailed assessment. The extensive assessment (and any re-assessments) is covered by the DCMP. If CMS identifies the recipient is not qualified for the GUIDE Design, the GUIDE Participant can bill for a proper Medicare-covered professional service that corresponds to the services rendered.