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GUIDE Individuals have the option, and are not needed, to make available reprieve through an adult day center or a 24-hour facility. Extra GUIDE Respite Providers requirements and information surrounding the payment for such services are specified in the Participation Agreement. GUIDE Individuals in the brand-new program track that are classified as safeguard service providers will be eligible to get a one-time facilities payment of $75,000 (geographically changed by the Geographic Adjustment Factor [GAF] to cover a few of the upfront expenses of establishing a brand-new dementia care program.

The facilities payment is planned for providers who want to develop new dementia care programs and require resources to begin. GUIDE Participants qualified as a safety net company based on the proportion of their client population that is dually qualified for Medicare and Medicaid or receive the Part D low-income subsidy.

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To certify as a GUIDE safety internet company, a new program applicant need to have had a Medicare FFS beneficiary population comprised of a minimum of 36% recipients getting the Part D low-income subsidy or 33.7% recipients who are dually eligible for Medicare and Medicaid. Accepting the facilities payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE reprieve services will go through beneficiary cost-sharing.

When an aligned recipient is re-assessed and assigned to a brand-new tier, the GUIDE Participant will be eligible to bill the G-code for the recognized client payment rate associated with that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the 2nd efficiency year will be needed to repay the whole worth of their facilities payment to CMS.

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After the 2nd performance year, GUIDE Individuals that withdraw or are ended from the GUIDE Model are not required to pay back the infrastructure 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 change fee-for-service payment for some existing Medicare Doctor Cost Schedule (PFS) services, including persistent care management and principal 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 Participants will continue to bill under standard Medicare fee-for-service for all services that are not consisted of under the DCMP. CMS may include or remove codes over time to show modifications in PFS billing codes.

The care group might include the beneficiary's medical care supplier, and if not, the care team is required to determine and share info with the beneficiary's main care service provider and experts and lay out the care coordination services needed to handle the beneficiary's dementia and co-occurring conditions. CMS will supply GUIDE Participants data related to the efficiency determines that CMS uses to determine the GUIDE Participant's performance-based change to the DCMP.GUIDE Individuals in the established program track must be prepared to begin furnishing services under the GUIDE Model on July 1, 2024, and expense for those services during the Model Performance Period.

Yes, GUIDE recipient and service provider overlap with the Shared Cost savings Program is allowed. The GUIDE Design is developed to be suitable with other CMS models and programs that intend to improve care and decrease costs. CMS thinks targeted assistance for people with dementia and their caregivers will help improve population-based care outcomes overall.

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As an example, if an ACO is taking part in both the GUIDE Design and the Shared Cost Savings Program during Efficiency Year 2024 and then renews and begins a new contract duration as of January 1, 2025, that ACO would have their Shared Cost savings Program criteria based on 2022, 2023 and 2024, and would have DCMPs counted in Standard Year 3. GUIDE Break Service claims will not be counted towards ACO expenditures, shared savings, nor benchmarking start in 2024 for the period of the GUIDE Model.

GUIDE Participants may participate in several CMS Innovation Center designs or Medicare value-based care efforts to speed up innovation in care shipment, minimize 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 Break Service claims in the REACH ACOs' overall expense of care expenditures or estimation of shared savings/shared losses.

Overlapping participants should follow GUIDE billing guidance as set forth listed below. GUIDE Break Service claims will not count towards ACO expenditures, shared cost savings, or benchmarking in 2025 and for the duration of the GUIDE Design.

As of January 1, 2025, GUIDE Individuals likewise participating in ACO REACH should discontinue billing the Medicare Physician Cost Set up Solutions consisted of under the DCMP (See Display 5 in the GUIDE Payment Method Paper (PDF)). Individuals getting involved in both models must follow the GUIDE billing requirements in the GUIDE Participation Arrangement and GUIDE Payment Approach Paper.

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The GUIDE Participant must not bill Medicare separately for the services supplied in the detailed assessment. The thorough evaluation (and any re-assessments) is covered by the DCMP. If CMS figures out the beneficiary is not eligible for the GUIDE Design, the GUIDE Individual can bill for an appropriate Medicare-covered expert service that corresponds to the services rendered.