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

The infrastructure payment is meant for suppliers who want to establish brand-new dementia care programs and need resources to get started. GUIDE Individuals qualified as a security net company based on the percentage 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 safeguard company, a new program applicant need to have had a Medicare FFS beneficiary population made up of at least 36% beneficiaries receiving the Part D low-income subsidy or 33.7% recipients who are dually qualified 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 beneficiary cost-sharing.

When a lined up recipient is re-assessed and assigned to a new tier, the GUIDE Participant will be eligible to bill the G-code for the recognized client payment rate connected with that tier the following month. GUIDE Participants that withdraw or are ended before the start of the second performance year will be needed to repay the whole 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 Model are not needed to repay the facilities payment. The main 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 replace fee-for-service payment for some existing Medicare Physician Charge Schedule (PFS) services, consisting of chronic care management and principal care management, transitional care management, advance care planning, 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 bill 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 show modifications in PFS billing codes.

The care group may consist of the recipient's medical care provider, and if not, the care group is needed to identify and share details with the recipient's medical care provider and specialists and lay out the care coordination services needed to manage the recipient's dementia and co-occurring conditions. CMS will provide GUIDE Participants information associated with the efficiency determines that CMS uses to figure out the GUIDE Individual's performance-based adjustment to the DCMP.GUIDE Participants in the established program track must be prepared to begin furnishing services under the GUIDE Design on July 1, 2024, and costs for those services during the Model Performance Period.

Yes, GUIDE beneficiary and provider overlap with the Shared Savings Program is enabled. The GUIDE Model is designed 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 caretakers will help improve population-based care results in general.

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The Dementia Care Management Payment (DCMP), the per beneficiary monthly GUIDE payment, will be included in 2024 Shared Cost savings Program expenditures. When 2024 ends up being a benchmark year, DCMPs will be consisted of in Shared Savings Program criteria calculations. As an example, if an ACO is taking part in both the GUIDE Model and the Shared Cost Savings Program throughout Efficiency Year 2024 and then renews and starts a brand-new agreement period as of January 1, 2025, that ACO would have their Shared Cost savings Program criteria based upon 2022, 2023 and 2024, and would have DCMPs counted in Standard Year 3. GUIDE Break Service claims will not be counted toward ACO expenses, shared savings, nor benchmarking beginning in 2024 for the period of the GUIDE Design.

GUIDE Participants might take part in several CMS Development Center models or Medicare value-based care initiatives to accelerate development in care delivery, reduce the expense of care, and enhance population health. Participants and recipients are eligible to take part in the GUIDE Model and the ACO REACH Model. For the rest of CY 2024, ACO REACH will not include the Dementia Care Management Payment (DCMP) or Reprieve Service claims in the REACH ACOs' overall expense of care expenditures or computation of shared savings/shared losses.

Overlapping participants need to follow GUIDE billing assistance as set forth listed below. GUIDE Break Service claims will not count toward ACO expenditures, shared cost savings, or benchmarking in 2025 and for the period of the GUIDE Design.

Since January 1, 2025, GUIDE Individuals also taking part in ACO REACH need to stop billing the Medicare Doctor Cost Set up Providers consisted of under the DCMP (See Exhibition 5 in the GUIDE Payment Approach Paper (PDF)). Individuals taking part in both designs should follow the GUIDE billing requirements in the GUIDE Participation Agreement and GUIDE Payment Method Paper.

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The GUIDE Participant should not bill Medicare separately for the services supplied in the extensive assessment. The thorough assessment (and any re-assessments) is covered by the DCMP. If CMS determines the beneficiary is not qualified for the GUIDE Model, the GUIDE Participant can bill for a proper Medicare-covered expert service that corresponds to the services rendered.