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GUIDE Participants have the option, and are not needed, to make offered respite through an adult day center or a 24-hour center. Extra GUIDE Respite Providers requirements and information surrounding the payment for such services are defined in the Involvement Arrangement.

The facilities payment is planned for service providers who want to establish new dementia care programs and require resources to start. GUIDE Individuals certified as a safety net company based upon 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 provider, a brand-new program candidate need to have had a Medicare FFS recipient population comprised of at least 36% beneficiaries getting the Part D low-income aid 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 go through recipient cost-sharing.

When an aligned recipient is re-assessed and appointed to a brand-new tier, the GUIDE Individual will be eligible 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 second efficiency year will be needed to pay back the whole value 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 required to repay the facilities payment. The primary 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 replace fee-for-service payment for some existing Medicare Doctor Fee Schedule (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 Model is not a total-cost-of-care model, so GUIDE Individuals will continue to expense under traditional Medicare fee-for-service for all services that are not consisted of under the DCMP. Additional details, including a complete list of duplicative codes, is available in the Ask for Applications (Table 8, pg. 35). CMS might include or get rid of codes gradually to show modifications in PFS billing codes.

The care team might include the beneficiary's medical care provider, and if not, the care team is required to recognize and share info with the recipient's primary care service provider and experts and lay out the care coordination services required to handle the recipient's dementia and co-occurring conditions. CMS will provide GUIDE Individuals data associated with the efficiency determines that CMS utilizes to figure out the GUIDE Participant's performance-based change to the DCMP.GUIDE Individuals in the established program track must be prepared to start providing services under the GUIDE Model on July 1, 2024, and costs for those services throughout the Design Efficiency Duration.

Yes, GUIDE recipient and company overlap with the Shared Savings Program is enabled. The GUIDE Model is developed to be compatible with other CMS designs and programs that intend to enhance care and reduce spending. CMS thinks targeted support for individuals with dementia and their caregivers will help improve population-based care results in general.

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The Dementia Care Management Payment (DCMP), the per beneficiary monthly GUIDE payment, will be consisted of in 2024 Shared Savings Program expenses. When 2024 becomes a benchmark year, DCMPs will be consisted of in Shared Savings Program benchmark calculations. As an example, if an ACO is taking part in both the GUIDE Model and the Shared Savings Program during Performance Year 2024 and then restores and starts a new contract period as of January 1, 2025, that ACO would have their Shared Savings Program standard based upon 2022, 2023 and 2024, and would have DCMPs counted in Standard Year 3. GUIDE Respite Service claims will not be counted towards ACO expenses, shared savings, nor benchmarking start in 2024 for the period of the GUIDE Model.

GUIDE Individuals might take part in multiple CMS Innovation Center designs or Medicare value-based care initiatives to accelerate innovation in care delivery, decrease the cost of care, and enhance population health. Participants and recipients are eligible 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 Break Service claims in the REACH ACOs' overall expense of care expenditures or estimation of shared savings/shared losses.

Overlapping participants ought to follow GUIDE billing guidance as set forth below. GUIDE Reprieve Service claims will not count towards ACO expenses, shared cost savings, or benchmarking in 2025 and for the period of the GUIDE Model.

As of January 1, 2025, GUIDE Individuals also taking part in ACO REACH need to terminate billing the Medicare Doctor Fee Arrange Services consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Methodology Paper (PDF)). Individuals participating in both designs should follow the GUIDE billing requirements in the GUIDE Participation Contract and GUIDE Payment Methodology Paper.

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The GUIDE Participant must not bill Medicare independently for the services offered in the comprehensive evaluation. The thorough assessment (and any re-assessments) is covered by the DCMP. If CMS identifies the recipient is not eligible for the GUIDE Design, the GUIDE Individual can bill for a suitable Medicare-covered expert service that corresponds to the services rendered.