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Nevertheless, GUIDE Individuals have the choice, and are not required, to make available break through an adult day center or a 24-hour facility. Additional GUIDE Respite Providers requirements and details surrounding the payment for such services are defined in the Involvement Arrangement. GUIDE Participants in the new program track that are classified as safeguard providers will be eligible to get a one-time facilities payment of $75,000 (geographically changed by the Geographic Adjustment Element [GAF] to cover a few of the in advance expenses of establishing a brand-new dementia care program.

The facilities payment is planned for providers who wish to develop brand-new dementia care programs and need resources to begin. GUIDE Participants certified as a safeguard service provider based on the proportion of their client population that is dually eligible for Medicare and Medicaid or get the Part D low-income subsidy.

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To certify as a GUIDE safeguard supplier, a new program candidate need to have had a Medicare FFS recipient population consisted of a minimum of 36% recipients 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 respite services will go through recipient cost-sharing.

When a lined up beneficiary is re-assessed and appointed to a brand-new tier, the GUIDE Individual 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 efficiency year will be required to pay back the entire value of their facilities payment to CMS.

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After the second performance year, GUIDE Participants that withdraw or are terminated from the GUIDE Design are not required to pay back the infrastructure payment. The main model 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 Schedule (PFS) services, consisting of chronic care management and primary care management, transitional care management, advance care preparation, 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 bill under standard Medicare fee-for-service for all services that are not included under the DCMP. CMS may add or get rid of codes over time to show changes in PFS billing codes.

The care team might consist of the recipient's medical care provider, and if not, the care group is required to identify and share details with the beneficiary's primary care company and experts and describe the care coordination services needed to handle the beneficiary's dementia and co-occurring conditions. CMS will supply GUIDE Participants information connected to the performance measures that CMS utilizes to identify the GUIDE Participant's performance-based change to the DCMP.GUIDE Individuals in the recognized program track must be prepared to begin furnishing services under the GUIDE Model on July 1, 2024, and costs for those services during the Model Efficiency Period.

Yes, GUIDE recipient and supplier overlap with the Shared Savings Program is allowed. The GUIDE Model is created to be compatible with other CMS models and programs that intend to improve care and lower costs. CMS believes targeted assistance for individuals with dementia and their caregivers will help improve population-based care outcomes in general.

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The Dementia Care Management Payment (DCMP), the per recipient each month GUIDE payment, will be consisted of in 2024 Shared Cost savings Program expenditures. When 2024 becomes a benchmark year, DCMPs will be included in Shared Cost savings Program standard estimations. As an example, if an ACO is getting involved in both the GUIDE Design and the Shared Savings Program throughout Performance Year 2024 and then renews and begins a brand-new agreement duration as of January 1, 2025, that ACO would have their Shared Cost savings Program benchmark based upon 2022, 2023 and 2024, and would have DCMPs counted in Standard Year 3. Nevertheless, GUIDE Reprieve Service claims will not be counted towards ACO expenditures, shared cost savings, nor benchmarking beginning in 2024 throughout of the GUIDE Design.

GUIDE Individuals may take part in several CMS Innovation Center designs or Medicare value-based care efforts to accelerate innovation in care shipment, lower the cost of care, and improve population health. Participants and beneficiaries are qualified to take part in the GUIDE Model and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not include the Dementia Care Management Payment (DCMP) or Break Service claims in the REACH ACOs' total cost of care expenses or estimation of shared savings/shared losses.

Overlapping individuals must follow GUIDE billing assistance as set forth below. GUIDE Reprieve Service claims will not count towards ACO expenditures, shared cost savings, or benchmarking in 2025 and for the duration of the GUIDE Model.

As of January 1, 2025, GUIDE Individuals likewise getting involved in ACO REACH need to stop billing the Medicare Physician Cost Set up Providers consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Method Paper (PDF)). Participants taking part in both models should follow the GUIDE billing requirements in the GUIDE Participation Arrangement and GUIDE Payment Methodology Paper.

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The GUIDE Participant must not bill Medicare independently for the services supplied in the comprehensive 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 Design, the GUIDE Individual can bill for a proper Medicare-covered professional service that represents the services rendered.