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GUIDE Participants have the option, and are not needed, to make available respite through an adult day center or a 24-hour center. Extra GUIDE Break Solutions requirements and details surrounding the payment for such services are defined in the Participation Arrangement. 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 adjusted by the Geographic Change Element [GAF] to cover a few of the upfront expenses of establishing a new dementia care program.

The infrastructure payment is intended for suppliers who desire to develop brand-new dementia care programs and need resources to start. GUIDE Participants qualified as a security net provider based on the proportion of their client 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 safety internet company, a new program candidate should have had a Medicare FFS recipient population comprised of a minimum of 36% recipients getting the Part D low-income aid 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 respite services will undergo beneficiary cost-sharing.

When an aligned beneficiary is re-assessed and assigned to a new tier, the GUIDE Participant will be qualified to bill the G-code for the established client payment rate associated with that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the 2nd performance year will be needed to repay the whole worth of their facilities 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 required to repay the infrastructure 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 Physician Cost Arrange (PFS) services, consisting of chronic care management and principal 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 conventional Medicare fee-for-service for all services that are not consisted of under the DCMP. Additional information, 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 gradually to reflect changes in PFS billing codes.

The care group may include the beneficiary's medical care provider, and if not, the care group is required to determine and share details with the beneficiary's primary care supplier and professionals and lay out the care coordination services needed to handle the recipient's dementia and co-occurring conditions. CMS will provide GUIDE Individuals information connected to the efficiency measures that CMS uses to identify the GUIDE Participant's performance-based change to the DCMP.GUIDE Individuals in the established program track should be prepared to start providing services under the GUIDE Design on July 1, 2024, and expense for those services during the Model Performance Duration.

Yes, GUIDE recipient and supplier overlap with the Shared Cost savings Program is permitted. The GUIDE Design is designed to be suitable with other CMS models and programs that aim to enhance care and reduce costs. CMS thinks targeted assistance for people with dementia and their caregivers will help enhance population-based care results in general.

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As an example, if an ACO is getting involved in both the GUIDE Model and the Shared Savings Program during Performance Year 2024 and then restores and starts a new agreement duration as of January 1, 2025, that ACO would have their Shared Savings Program benchmark based on 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 beginning in 2024 for the period of the GUIDE Model.

GUIDE Individuals may take part in multiple CMS Development Center designs or Medicare value-based care initiatives to speed up development in care shipment, decrease the cost of care, and enhance population health. Individuals and beneficiaries are qualified to take part in the GUIDE Design 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 expenses or computation of shared savings/shared losses.

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

As of January 1, 2025, GUIDE Individuals likewise participating in ACO REACH should discontinue billing the Medicare Physician Charge Set up Solutions consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Approach Paper (PDF)). Individuals taking part in both designs need to follow the GUIDE billing requirements in the GUIDE Participation Arrangement and GUIDE Payment Method Paper.

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The GUIDE Participant must not bill Medicare separately for the services provided in the detailed assessment. The thorough assessment (and any re-assessments) is covered by the DCMP. If CMS determines the recipient is not qualified for the GUIDE Model, the GUIDE Participant can bill for a suitable Medicare-covered expert service that corresponds to the services rendered.