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GUIDE Participants have the alternative, and are not required, to make offered reprieve through an adult day center or a 24-hour facility. Extra GUIDE Respite Services requirements and details surrounding the payment for such services are specified in the Participation Contract.

The infrastructure payment is intended for suppliers who wish to develop new dementia care programs and require resources to start. GUIDE Participants qualified as a safeguard service provider based on the percentage of their client population that is dually qualified for Medicare and Medicaid or get the Part D low-income aid.

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To certify as a GUIDE safeguard supplier, a brand-new program candidate should have had a Medicare FFS beneficiary population consisted of a minimum of 36% recipients receiving the Part D low-income aid or 33.7% recipients who are dually qualified for Medicare and Medicaid. Accepting the infrastructure payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE break services will be subject to beneficiary cost-sharing.

When a lined up beneficiary 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 related to that tier the following month. GUIDE Individuals that withdraw or are ended before the start of the second performance year will be needed to repay the whole worth of their infrastructure payment to CMS.

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After the 2nd performance year, GUIDE Participants that withdraw or are ended from the GUIDE Design are not required to repay the facilities 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 Doctor Charge Arrange (PFS) services, consisting of chronic care management and principal care management, transitional care management, advance care preparation, and technology-based check-ins.

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The GUIDE Model is not a total-cost-of-care model, so GUIDE Individuals will continue to bill under traditional Medicare fee-for-service for all services that are not consisted of under the DCMP. CMS may add or eliminate codes over time to show changes in PFS billing codes.

The care team may consist of the recipient's medical care company, and if not, the care group is needed to determine and share info with the recipient's medical care service provider and experts and describe the care coordination services required to manage the recipient's dementia and co-occurring conditions. CMS will offer GUIDE Participants information connected to the performance determines that CMS uses to identify the GUIDE Individual's performance-based adjustment to the DCMP.GUIDE Participants in the established program track need to be prepared to begin furnishing services under the GUIDE Model on July 1, 2024, and bill for those services during the Model Efficiency Period.

Yes, GUIDE beneficiary and service provider overlap with the Shared Savings Program is permitted. The GUIDE Design is designed to be suitable with other CMS designs and programs that intend to enhance care and reduce costs. CMS believes targeted assistance for individuals with dementia and their caregivers will help improve population-based care outcomes in general.

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The Dementia Care Management Payment (DCMP), the per beneficiary each month GUIDE payment, will be consisted of in 2024 Shared Savings Program expenditures. When 2024 becomes a benchmark year, DCMPs will be included in Shared Cost savings Program benchmark calculations. As an example, if an ACO is taking part in both the GUIDE Model and the Shared Cost Savings Program throughout Performance Year 2024 and then restores and begins a brand-new arrangement duration since January 1, 2025, that ACO would have their Shared Savings Program criteria based upon 2022, 2023 and 2024, and would have DCMPs counted in Benchmark Year 3. GUIDE Break Service claims will not be counted towards ACO expenses, shared savings, nor benchmarking start in 2024 for the duration of the GUIDE Design.

GUIDE Individuals might take part in multiple CMS Innovation Center designs or Medicare value-based care efforts to accelerate innovation in care delivery, minimize the expense of care, and enhance population health. Participants and recipients are qualified 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 Respite Service declares in the REACH ACOs' overall cost of care expenditures or computation of shared savings/shared losses.

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

Since January 1, 2025, GUIDE Individuals also taking part in ACO REACH should stop billing the Medicare Doctor Charge Arrange Solutions consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Approach Paper (PDF)). Participants taking part in both designs should follow the GUIDE billing requirements in the GUIDE Participation Arrangement and GUIDE Payment Method Paper.

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