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GUIDE Participants have the choice, and are not needed, to make available reprieve through an adult day center or a 24-hour facility. Additional GUIDE Reprieve Solutions requirements and information surrounding the payment for such services are defined in the Participation Arrangement.

The infrastructure payment is intended for service providers who wish to develop new dementia care programs and require resources to get begun. GUIDE Individuals certified as a security net service provider based upon the proportion of their patient population that is dually eligible for Medicare and Medicaid or receive the Part D low-income subsidy.

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To certify as a GUIDE safety web company, a new program candidate need to have had a Medicare FFS recipient population made up 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 be subject to recipient cost-sharing.

When a lined up recipient 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 related to that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the second performance year will be required to repay the whole worth of their infrastructure payment to CMS.

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After the second performance year, GUIDE Participants that withdraw or are ended from the GUIDE Model are not required to pay back the facilities payment. The main 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 replace fee-for-service payment for some existing Medicare Physician Cost Schedule (PFS) services, consisting of persistent 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 design, so GUIDE Individuals will continue to bill under standard Medicare fee-for-service for all services that are not consisted of 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 main care service provider, and if not, the care team is required to determine and share information with the recipient's primary care provider and professionals and detail the care coordination services needed to handle the recipient's dementia and co-occurring conditions. CMS will supply GUIDE Participants information associated with the efficiency measures that CMS uses to figure out the GUIDE Participant's performance-based change to the DCMP.GUIDE Individuals in the established program track must be prepared to start providing services under the GUIDE Model on July 1, 2024, and costs for those services throughout the Design Efficiency Duration.

Yes, GUIDE recipient and provider overlap with the Shared Savings Program is permitted. The GUIDE Design is developed to be compatible with other CMS models and programs that aim to enhance care and reduce spending. CMS believes targeted assistance for individuals with dementia and their caregivers will help enhance population-based care results overall.

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

GUIDE Participants may get involved in numerous CMS Innovation Center models or Medicare value-based care initiatives to accelerate innovation in care shipment, decrease the cost of care, and enhance population health. Individuals and beneficiaries are qualified to participate in the GUIDE Design and the ACO REACH Model. 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 calculation of shared savings/shared losses.

Overlapping participants ought to follow GUIDE billing guidance as stated below. ACO REACH claim decreases will not apply to DCMP. ACO REACH will consist of DCMP expenditures for functions of alignment computations. However, GUIDE Respite Service claims will not count towards ACO expenditures, shared savings, or benchmarking in 2025 and throughout of the GUIDE Model.

Since January 1, 2025, GUIDE Participants also taking part in ACO REACH should discontinue billing the Medicare Doctor Fee Set up Solutions included under the DCMP (See Display 5 in the GUIDE Payment Approach Paper (PDF)). Participants getting involved in both designs need to follow the GUIDE billing requirements in the GUIDE Participation Arrangement and GUIDE Payment Method Paper.

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The GUIDE Participant need to not bill Medicare separately for the services provided in the detailed assessment. The extensive evaluation (and any re-assessments) is covered by the DCMP. If CMS figures out the beneficiary is not qualified for the GUIDE Model, the GUIDE Individual can bill for a suitable Medicare-covered professional service that represents the services rendered.