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GUIDE Participants have the option, and are not required, to make offered respite through an adult day center or a 24-hour facility. Extra GUIDE Break Providers requirements and details surrounding the payment for such services are defined in the Involvement Agreement. GUIDE Participants in the new program track that are classified as security net suppliers will be qualified to get a one-time facilities payment of $75,000 (geographically adjusted by the Geographic Modification Factor [GAF] to cover a few of the in advance costs of developing a brand-new dementia care program.

The infrastructure payment is planned for service providers who wish to establish new dementia care programs and need resources to begin. GUIDE Participants certified as a safeguard service provider 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 qualify as a GUIDE security web company, a new program candidate must have had a Medicare FFS beneficiary population consisted of at least 36% beneficiaries getting 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 appointed to a new tier, the GUIDE Participant will be qualified to bill the G-code for the established patient payment rate connected with that tier the following month. GUIDE Individuals that withdraw or are ended before the start of the 2nd performance year will be required to pay back the whole worth of their infrastructure payment to CMS.

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After the 2nd performance year, GUIDE Participants that withdraw or are terminated from the GUIDE Model are not needed to pay back the infrastructure payment. The primary 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 Charge Set Up (PFS) services, including chronic care management and principal care management, transitional care management, advance care planning, 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 traditional Medicare fee-for-service for all services that are not included under the DCMP. CMS might include or remove codes over time to show modifications in PFS billing codes.

The care team might consist of the beneficiary's main care service provider, and if not, the care team is required to identify and share details with the recipient's primary care service provider and specialists and lay out the care coordination services needed to handle the recipient's dementia and co-occurring conditions. CMS will supply GUIDE Individuals information associated with the performance measures that CMS uses to determine the GUIDE Participant's performance-based adjustment to the DCMP.GUIDE Participants in the established program track need to be prepared to start furnishing services under the GUIDE Design on July 1, 2024, and costs for those services throughout the Design Performance Period.

Yes, GUIDE beneficiary and company overlap with the Shared Savings Program is allowed. The GUIDE Design is developed to be suitable with other CMS designs and programs that aim to improve care and minimize costs. CMS believes targeted support for individuals with dementia and their caregivers will help enhance population-based care results in general.

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As an example, if an ACO is participating in both the GUIDE Design and the Shared Cost Savings Program throughout Efficiency Year 2024 and then restores and begins a brand-new contract duration 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 Benchmark Year 3. GUIDE Break Service claims will not be counted toward ACO expenses, shared savings, nor benchmarking start in 2024 for the duration of the GUIDE Design.

GUIDE Individuals may take part in numerous CMS Development Center designs or Medicare value-based care efforts to speed up development in care shipment, lower the cost of care, and enhance population health. Participants and recipients are eligible to take part in the GUIDE Design and the ACO REACH Model. For the rest of CY 2024, ACO REACH will not include the Dementia Care Management Payment (DCMP) or Break Service declares in the REACH ACOs' total cost of care expenses or calculation of shared savings/shared losses.

Overlapping individuals should follow GUIDE billing assistance as set forth below. ACO REACH claim decreases will not use to DCMP. ACO REACH will include DCMP expenses for purposes of alignment calculations. However, GUIDE Break Service claims will not count towards ACO expenses, shared cost savings, or benchmarking in 2025 and throughout of the GUIDE Design.

Since January 1, 2025, GUIDE Individuals also participating in ACO REACH ought to stop billing the Medicare Doctor Cost Schedule Solutions consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Approach Paper (PDF)). Participants taking part in both models need to follow the GUIDE billing requirements in the GUIDE Participation Agreement and GUIDE Payment Approach Paper.

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The GUIDE Individual must not bill Medicare individually for the services supplied in the detailed evaluation. The detailed assessment (and any re-assessments) is covered by the DCMP. If CMS identifies the beneficiary is not qualified for the GUIDE Design, the GUIDE Participant can bill for an appropriate Medicare-covered expert service that represents the services rendered.