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GUIDE Individuals have the alternative, and are not required, to make offered break through an adult day center or a 24-hour center. Extra GUIDE Reprieve Solutions requirements and information surrounding the payment for such services are specified in the Participation Contract.

The infrastructure payment is meant for service providers who want to develop brand-new dementia care programs and need resources to get started. GUIDE Participants qualified as a safeguard supplier based on the percentage of their client population that is dually eligible for Medicare and Medicaid or get the Part D low-income aid.

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To certify as a GUIDE safeguard provider, a brand-new program candidate must 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 undergo beneficiary cost-sharing.

When an aligned recipient is re-assessed and assigned to a new tier, the GUIDE Individual will be qualified to bill the G-code for the recognized client payment rate related to that tier the following month. GUIDE Individuals that withdraw or are terminated before the start of the 2nd performance year will be required to repay the whole value 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 Design 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 change fee-for-service payment for some existing Medicare Doctor Charge Arrange (PFS) services, consisting of persistent care management and primary 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 design, so GUIDE Participants will continue to bill under standard Medicare fee-for-service for all services that are not consisted of under the DCMP. Additional information, including a total list of duplicative codes, is readily available in the Request for Applications (Table 8, pg. 35). CMS might add or remove codes with time to show modifications in PFS billing codes.

The care team might consist of the beneficiary's main care supplier, and if not, the care group is required to recognize and share info with the beneficiary's primary care service provider and experts and outline the care coordination services needed to manage the beneficiary's dementia and co-occurring conditions. CMS will supply GUIDE Individuals data associated with the performance measures that CMS utilizes to figure out the GUIDE Individual's performance-based adjustment to the DCMP.GUIDE Individuals in the recognized program track must be prepared to begin providing 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 enabled. The GUIDE Design is created to be compatible with other CMS designs and programs that intend to enhance care and decrease costs. CMS believes targeted support for individuals with dementia and their caregivers will help improve population-based care outcomes overall.

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As an example, if an ACO is getting involved in both the GUIDE Design and the Shared Savings Program during Performance Year 2024 and then restores and begins a brand-new arrangement duration 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 Break Service claims will not be counted towards ACO expenditures, shared savings, nor benchmarking start in 2024 for the period of the GUIDE Model.

GUIDE Participants might take part in several CMS Development Center designs or Medicare value-based care efforts to accelerate innovation in care shipment, decrease the cost of care, and enhance population health. Individuals and recipients are qualified to take part in the GUIDE Design and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not include the Dementia Care Management Payment (DCMP) or Respite Service claims in the REACH ACOs' total expense 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 include DCMP expenses for purposes of alignment estimations. GUIDE Reprieve Service claims will not count toward ACO expenses, shared savings, or benchmarking in 2025 and for the period of the GUIDE Design.

As of January 1, 2025, GUIDE Participants also taking part in ACO REACH ought to cease billing the Medicare Doctor Cost Set up Solutions consisted of under the DCMP (See Display 5 in the GUIDE Payment Methodology Paper (PDF)). Participants participating in both designs must follow the GUIDE billing requirements in the GUIDE Participation Arrangement and GUIDE Payment Method Paper.

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The GUIDE Participant should not bill Medicare independently for the services supplied in the thorough evaluation. The extensive evaluation (and any re-assessments) is covered by the DCMP. If CMS figures out the recipient is not qualified for the GUIDE Model, the GUIDE Participant can bill for a proper Medicare-covered expert service that represents the services rendered.