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GUIDE Participants have the alternative, and are not needed, to make readily available reprieve through an adult day center or a 24-hour facility. Extra GUIDE Reprieve Providers requirements and details surrounding the payment for such services are specified in the Participation Arrangement.

The facilities payment is meant for companies who wish to develop brand-new dementia care programs and require resources to get started. GUIDE Participants qualified as a safety net company based upon the percentage of their patient population that is dually eligible for Medicare and Medicaid or receive the Part D low-income aid.

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To certify as a GUIDE safeguard service provider, a new program applicant need to have had a Medicare FFS beneficiary population made up of at least 36% beneficiaries receiving 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 break services will undergo beneficiary cost-sharing.

When a lined up recipient is re-assessed and assigned to a new tier, the GUIDE Participant will be eligible to bill the G-code for the established patient payment rate associated with that tier the following month. GUIDE Individuals that withdraw or are terminated before the start of the second performance year will be required to repay the whole value of their infrastructure payment to CMS.

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After the second performance year, GUIDE Individuals that withdraw or are ended from the GUIDE Design are not required to pay back 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 replace fee-for-service payment for some existing Medicare Physician Cost Schedule (PFS) services, consisting of persistent care management and primary 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 standard Medicare fee-for-service for all services that are not included under the DCMP. Extra info, consisting of a complete list of duplicative codes, is readily available in the Ask for Applications (Table 8, pg. 35). CMS may include or eliminate codes in time to show modifications in PFS billing codes.

The care group may include the beneficiary's medical care supplier, and if not, the care team is required to recognize and share information with the recipient's medical care service provider and professionals and detail the care coordination services required to manage the recipient's dementia and co-occurring conditions. CMS will supply GUIDE Individuals information related to the efficiency measures that CMS utilizes to identify the GUIDE Participant's performance-based modification to the DCMP.GUIDE Participants in the established program track must be prepared to begin furnishing services under the GUIDE Model on July 1, 2024, and costs for those services throughout the Design Performance Duration.

Yes, GUIDE beneficiary and provider overlap with the Shared Savings Program is allowed. The GUIDE Design is created to be compatible with other CMS designs and programs that intend to enhance care and lower spending. CMS believes targeted support for individuals with dementia and their caregivers will assist enhance population-based care outcomes overall.

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As an example, if an ACO is participating in both the GUIDE Design and the Shared Savings Program during Performance Year 2024 and then renews and begins a brand-new agreement duration as of January 1, 2025, that ACO would have their Shared Cost savings Program benchmark based on 2022, 2023 and 2024, and would have DCMPs counted in Criteria Year 3. GUIDE Reprieve Service claims will not be counted toward ACO expenditures, shared cost savings, nor benchmarking beginning in 2024 for the duration of the GUIDE Model.

GUIDE Participants might participate in multiple CMS Development Center models or Medicare value-based care efforts to speed up development in care delivery, reduce the expense of care, and improve population health. Individuals and beneficiaries 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' total cost of care expenditures or calculation of shared savings/shared losses.

Overlapping participants need to follow GUIDE billing assistance as stated listed below. ACO REACH claim reductions will not apply to DCMP. ACO REACH will include DCMP expenses for purposes of positioning estimations. GUIDE Respite Service claims will not count towards ACO expenses, shared savings, or benchmarking in 2025 and for the duration of the GUIDE Design.

Since January 1, 2025, GUIDE Participants likewise taking part in ACO REACH ought to cease billing the Medicare Doctor Fee Set up Solutions consisted of under the DCMP (See Display 5 in the GUIDE Payment Method Paper (PDF)). Individuals taking part in both designs must follow the GUIDE billing requirements in the GUIDE Involvement Agreement and GUIDE Payment Approach Paper.

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The GUIDE Participant should not bill Medicare individually for the services supplied in the detailed evaluation. The thorough assessment (and any re-assessments) is covered by the DCMP. If CMS identifies the beneficiary is not qualified for the GUIDE Model, the GUIDE Participant can bill for a proper Medicare-covered professional service that corresponds to the services rendered.