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GUIDE Individuals have the alternative, and are not needed, to make offered respite through an adult day center or a 24-hour center. Additional GUIDE Break Solutions requirements and details surrounding the payment for such services are specified in the Involvement Contract.

The infrastructure payment is planned for providers who wish to establish new dementia care programs and require resources to get started. GUIDE Participants qualified as a safeguard company based upon the proportion of their patient population that is dually eligible for Medicare and Medicaid or get the Part D low-income subsidy.

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To certify as a GUIDE safety web service provider, a new program applicant must have had a Medicare FFS recipient population made up of a minimum of 36% beneficiaries getting the Part D low-income subsidy or 33.7% beneficiaries 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 designated to a brand-new tier, the GUIDE Participant will be eligible to bill the G-code for the recognized patient payment rate associated with that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the second performance year will be needed to pay back the whole value of their infrastructure payment to CMS.

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After the second efficiency year, GUIDE Participants that withdraw or are terminated from the GUIDE Model are not needed to repay the infrastructure payment. The primary 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 change fee-for-service payment for some existing Medicare Physician Charge Arrange (PFS) services, including persistent care management and principal care management, transitional care management, advance care preparation, 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 costs under conventional Medicare fee-for-service for all services that are not included under the DCMP. Additional details, consisting of a complete list of duplicative codes, is available in the Request for Applications (Table 8, pg. 35). CMS may add or eliminate codes over time to reflect modifications in PFS billing codes.

The care group may consist of the recipient's medical care service provider, and if not, the care team is required to recognize and share info with the recipient's main care service provider and specialists and describe the care coordination services required to manage the beneficiary's dementia and co-occurring conditions. CMS will provide GUIDE Participants data associated with the performance measures that CMS uses to figure out the GUIDE Individual's performance-based change to the DCMP.GUIDE Individuals in the established program track need to be prepared to begin providing services under the GUIDE Model on July 1, 2024, and expense for those services throughout the Design Performance Duration.

Yes, GUIDE beneficiary and service provider overlap with the Shared Cost savings Program is enabled. The GUIDE Design is developed to be suitable with other CMS models and programs that aim to enhance care and decrease costs. CMS believes targeted assistance for people with dementia and their caregivers will assist enhance population-based care outcomes overall.

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The Dementia Care Management Payment (DCMP), the per recipient each month GUIDE payment, will be included in 2024 Shared Savings Program expenses. When 2024 ends up being a benchmark year, DCMPs will be included in Shared Savings Program benchmark calculations. As an example, if an ACO is taking part in both the GUIDE Design and the Shared Savings Program during Efficiency Year 2024 and then renews and begins a new agreement duration since January 1, 2025, that ACO would have their Shared Savings Program benchmark based upon 2022, 2023 and 2024, and would have DCMPs counted in Criteria Year 3. However, GUIDE Reprieve Service claims will not be counted towards ACO expenses, shared savings, nor benchmarking beginning in 2024 throughout of the GUIDE Design.

GUIDE Participants may take part in numerous CMS Innovation Center designs or Medicare value-based care efforts to speed up innovation in care delivery, lower the cost of care, and improve population health. Participants and recipients are qualified to take part in the GUIDE Model and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not include the Dementia Care Management Payment (DCMP) or Reprieve Service declares in the REACH ACOs' overall cost of care expenses or calculation of shared savings/shared losses.

Overlapping participants need to follow GUIDE billing guidance as stated listed below. ACO REACH claim reductions will not use to DCMP. ACO REACH will consist of DCMP expenditures for functions of alignment calculations. However, GUIDE Respite Service claims will not count toward ACO expenditures, shared cost savings, or benchmarking in 2025 and for the duration of the GUIDE Design.

As of January 1, 2025, GUIDE Participants likewise getting involved in ACO REACH should stop billing the Medicare Doctor Charge Arrange Solutions consisted of under the DCMP (See Display 5 in the GUIDE Payment Method Paper (PDF)). Participants taking part in both models should follow the GUIDE billing requirements in the GUIDE Participation Contract and GUIDE Payment Method Paper.

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The GUIDE Individual must not bill Medicare independently for the services supplied in the extensive assessment. The extensive evaluation (and any re-assessments) is covered by the DCMP. If CMS determines the beneficiary is not eligible for the GUIDE Design, the GUIDE Individual can bill for a proper Medicare-covered professional service that corresponds to the services rendered.