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GUIDE Participants have the alternative, and are not needed, to make offered break through an adult day center or a 24-hour center. Extra GUIDE Respite Services requirements and information surrounding the payment for such services are specified in the Involvement Contract. GUIDE Participants in the new program track that are classified as safeguard companies will be qualified to receive a one-time facilities payment of $75,000 (geographically changed by the Geographic Modification Aspect [GAF] to cover a few of the in advance costs of developing a brand-new dementia care program.

The facilities payment is intended for suppliers who wish to develop new dementia care programs and need resources to begin. GUIDE Participants certified as a safety net company based upon the percentage of their patient population that is dually qualified for Medicare and Medicaid or receive the Part D low-income aid.

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To certify as a GUIDE safeguard supplier, a brand-new program candidate should have had a Medicare FFS recipient population comprised of at least 36% beneficiaries 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 recipient cost-sharing.

When an aligned beneficiary is re-assessed and assigned to a brand-new tier, the GUIDE Participant will be qualified to bill the G-code for the established patient payment rate associated with that tier the following month. GUIDE Individuals that withdraw or are ended before the start of the second performance year will be needed to repay the entire value of their facilities payment to CMS.

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After the 2nd efficiency year, GUIDE Individuals that withdraw or are ended from the GUIDE Design are not required to repay the infrastructure 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 Cost Set Up (PFS) services, including 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 conventional Medicare fee-for-service for all services that are not included under the DCMP. Additional details, including a complete list of duplicative codes, is available in the Ask for Applications (Table 8, pg. 35). CMS may add or remove codes over time to reflect modifications in PFS billing codes.

The care team might consist of the beneficiary's medical care service provider, and if not, the care team is needed to identify and share info with the recipient's main care company and experts and detail the care coordination services needed to handle the beneficiary's dementia and co-occurring conditions. CMS will provide GUIDE Individuals data associated with the performance determines that CMS uses to determine the GUIDE Participant's performance-based modification to the DCMP.GUIDE Individuals in the recognized program track should be prepared to start providing services under the GUIDE Model on July 1, 2024, and expense for those services throughout the Model Performance Duration.

Yes, GUIDE recipient and supplier overlap with the Shared Savings Program is allowed. The GUIDE Model is developed to be suitable with other CMS models and programs that intend to improve care and minimize spending. CMS believes targeted support for people with dementia and their caretakers will help improve population-based care results overall.

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The Dementia Care Management Payment (DCMP), the per recipient monthly GUIDE payment, will be included in 2024 Shared Savings Program expenditures. When 2024 ends up being a benchmark year, DCMPs will be consisted of in Shared Cost savings Program standard computations. As an example, if an ACO is taking part in both the GUIDE Design and the Shared Savings Program during Efficiency Year 2024 and then renews and begins a brand-new contract period as of January 1, 2025, that ACO would have their Shared Savings Program standard based on 2022, 2023 and 2024, and would have DCMPs counted in Benchmark Year 3. GUIDE Respite Service claims will not be counted towards ACO expenses, shared savings, nor benchmarking start in 2024 for the duration of the GUIDE Design.

GUIDE Participants might take part in numerous CMS Development Center models or Medicare value-based care initiatives to speed up innovation in care delivery, minimize the cost of care, and improve population health. Participants and recipients 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 declares in the REACH ACOs' overall cost of care expenses or computation of shared savings/shared losses.

Overlapping individuals should follow GUIDE billing assistance as stated below. ACO REACH claim reductions will not use to DCMP. ACO REACH will consist of DCMP expenses for functions of positioning estimations. GUIDE Break Service claims will not count towards ACO expenses, shared cost savings, or benchmarking in 2025 and for the period of the GUIDE Model.

Since January 1, 2025, GUIDE Participants also participating in ACO REACH need to discontinue billing the Medicare Doctor Charge Set up Solutions included under the DCMP (See Exhibition 5 in the GUIDE Payment Method Paper (PDF)). Individuals taking part in both models must follow the GUIDE billing requirements in the GUIDE Participation Agreement and GUIDE Payment Methodology Paper.

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