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GUIDE Individuals have the alternative, and are not needed, to make offered break through an adult day center or a 24-hour center. Additional GUIDE Reprieve Providers requirements and details surrounding the payment for such services are defined in the Participation Contract. GUIDE Participants in the new program track that are classified as safeguard providers will be qualified to get a one-time facilities payment of $75,000 (geographically changed by the Geographic Adjustment Element [GAF] to cover some of the in advance expenses of establishing a brand-new dementia care program.

The facilities payment is intended for companies who want to establish brand-new dementia care programs and require resources to get going. GUIDE Individuals certified as a security net supplier based upon the proportion of their client population that is dually qualified for Medicare and Medicaid or get the Part D low-income subsidy.

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To qualify as a GUIDE security internet company, a new program candidate should have had a Medicare FFS beneficiary population made up of a minimum of 36% beneficiaries receiving the Part D low-income subsidy or 33.7% recipients who are dually eligible for Medicare and Medicaid. Accepting the infrastructure payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE reprieve services will undergo beneficiary cost-sharing.

When an aligned beneficiary is re-assessed and appointed to a new tier, the GUIDE Individual will be eligible to bill the G-code for the recognized patient payment rate associated 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 repay the entire value of their facilities payment to CMS.

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After the 2nd efficiency year, GUIDE Individuals that withdraw or are ended from the GUIDE Model are not required 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 Doctor Fee Set Up (PFS) services, consisting of persistent 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 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. Extra details, including a complete list of duplicative codes, is readily available in the Ask for Applications (Table 8, pg. 35). CMS might add or get rid of codes over time to reflect changes in PFS billing codes.

The care team may include the beneficiary's main care company, and if not, the care group is needed to identify and share information with the recipient's primary care company and experts and describe the care coordination services required to manage the recipient's dementia and co-occurring conditions. CMS will supply GUIDE Participants information connected to the performance determines that CMS utilizes to determine the GUIDE Individual's performance-based change to the DCMP.GUIDE Participants in the recognized program track should be prepared to start providing services under the GUIDE Model on July 1, 2024, and costs for those services throughout the Design Performance Period.

Yes, GUIDE beneficiary and service provider overlap with the Shared Savings Program is enabled. The GUIDE Model is developed to be suitable with other CMS models and programs that aim to improve care and reduce costs. CMS believes targeted support for people with dementia and their caregivers will assist enhance population-based care outcomes in general.

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The Dementia Care Management Payment (DCMP), the per recipient per month GUIDE payment, will be consisted of in 2024 Shared Cost savings Program expenditures. When 2024 ends up being a benchmark year, DCMPs will be consisted of in Shared Cost savings Program criteria calculations. As an example, if an ACO is getting involved in both the GUIDE Design and the Shared Cost Savings Program during Performance Year 2024 and then renews and starts a brand-new agreement period 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 Benchmark Year 3. GUIDE Respite Service claims will not be counted towards ACO expenses, shared savings, nor benchmarking start in 2024 for the duration of the GUIDE Design.

GUIDE Participants might take part in several CMS Development Center models or Medicare value-based care initiatives to speed up development in care delivery, reduce the cost of care, and enhance population health. Individuals 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 consist of the Dementia Care Management Payment (DCMP) or Break Service claims in the REACH ACOs' total expense of care expenses or computation of shared savings/shared losses.

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

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

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The GUIDE Individual need to not bill Medicare independently for the services provided in the thorough 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 an appropriate Medicare-covered expert service that represents the services rendered.