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GUIDE Individuals have the alternative, and are not needed, to make readily available respite through an adult day center or a 24-hour center. Extra GUIDE Break Providers requirements and details surrounding the payment for such services are specified in the Participation Arrangement.

The facilities payment is planned for suppliers who wish to develop brand-new dementia care programs and require resources to begin. GUIDE Participants certified as a security net company based upon the proportion 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 safety net service provider, a brand-new program candidate must have had a Medicare FFS recipient population made up of a minimum of 36% beneficiaries getting the Part D low-income aid or 33.7% beneficiaries 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 beneficiary cost-sharing.

When an aligned recipient is re-assessed and designated to a brand-new tier, the GUIDE Individual will be qualified to bill the G-code for the established client payment rate related to that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the 2nd efficiency year will be required to pay back the entire worth of their infrastructure payment to CMS.

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After the 2nd efficiency year, GUIDE Participants that withdraw or are terminated from the GUIDE Design are not needed to repay the facilities 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 Physician Fee Set Up (PFS) services, consisting of chronic 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 Individuals will continue to expense under conventional Medicare fee-for-service for all services that are not consisted of under the DCMP. CMS might include or remove codes over time to reflect changes in PFS billing codes.

The care team may include the beneficiary's main care provider, and if not, the care team is required to recognize and share info with the beneficiary's medical care company and specialists and describe the care coordination services needed to handle the recipient's dementia and co-occurring conditions. CMS will provide GUIDE Individuals data associated with the performance measures that CMS utilizes to figure out 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 expense for those services throughout the Model Performance Period.

Yes, GUIDE recipient and provider overlap with the Shared Cost savings Program is permitted. The GUIDE Model is designed to be compatible 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 assist enhance population-based care outcomes in general.

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As an example, if an ACO is getting involved in both the GUIDE Model and the Shared Cost Savings Program during Performance Year 2024 and then renews and starts a new contract period as of January 1, 2025, that ACO would have their Shared Cost savings Program standard based on 2022, 2023 and 2024, and would have DCMPs counted in Criteria Year 3. GUIDE Break Service claims will not be counted towards ACO expenditures, shared cost savings, nor benchmarking beginning in 2024 for the period of the GUIDE Design.

GUIDE Participants might take part in multiple CMS Development Center models or Medicare value-based care efforts to accelerate development in care shipment, minimize the cost of care, and enhance population health. Individuals and beneficiaries are eligible to get involved 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' total cost of care expenditures or estimation of shared savings/shared losses.

Overlapping participants should follow GUIDE billing guidance as set forth below. GUIDE Break Service claims will not count toward ACO expenditures, shared cost savings, or benchmarking in 2025 and for the duration of the GUIDE Model.

As of January 1, 2025, GUIDE Individuals also getting involved in ACO REACH must terminate billing the Medicare Physician Fee Schedule Solutions included under the DCMP (See Display 5 in the GUIDE Payment Methodology Paper (PDF)). Participants getting involved in both models need to 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 individually for the services provided in the extensive assessment. The extensive evaluation (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 corresponds to the services rendered.