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GUIDE Individuals have the alternative, and are not required, to make readily available respite through an adult day center or a 24-hour facility. Extra GUIDE Respite Solutions requirements and information surrounding the payment for such services are specified in the Participation Agreement.

The facilities payment is meant for providers who wish to develop new dementia care programs and require resources to get started. GUIDE Individuals qualified as a safety net company 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 qualify as a GUIDE security net service provider, a new program applicant should have had a Medicare FFS recipient population made up of at least 36% recipients getting the Part D low-income aid 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 break services will be subject to beneficiary cost-sharing.

When an aligned recipient is re-assessed and assigned to a new tier, the GUIDE Participant will be qualified to bill the G-code for the recognized client payment rate connected with that tier the following month. GUIDE Individuals that withdraw or are terminated before the start of the 2nd performance year will be needed to repay the entire value of their infrastructure payment to CMS.

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After the second performance year, GUIDE Individuals that withdraw or are terminated from the GUIDE Model are not needed to pay back the infrastructure payment. The main 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 Cost Schedule (PFS) services, including chronic care management and principal care management, transitional care management, advance care preparation, and technology-based check-ins.

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The GUIDE Design is not a total-cost-of-care design, so GUIDE Participants will continue to costs under traditional Medicare fee-for-service for all services that are not consisted of under the DCMP. CMS might include or eliminate codes over time to reflect modifications in PFS billing codes.

The care group might include the recipient's main care provider, and if not, the care group is required to identify and share information with the recipient's primary care service provider and professionals and lay out the care coordination services needed to manage the beneficiary's dementia and co-occurring conditions. CMS will offer GUIDE Participants information related to the efficiency measures that CMS utilizes to determine the GUIDE Participant's performance-based change to the DCMP.GUIDE Participants 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 during the Model Efficiency Duration.

Yes, GUIDE beneficiary and supplier overlap with the Shared Savings Program is allowed. The GUIDE Design is developed to be suitable with other CMS models and programs that aim to improve care and reduce costs. CMS thinks targeted support for people with dementia and their caretakers will help improve population-based care outcomes in general.

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The Dementia Care Management Payment (DCMP), the per recipient monthly GUIDE payment, will be included 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 benchmark calculations. As an example, if an ACO is getting involved in both the GUIDE Model and the Shared Savings Program throughout Efficiency Year 2024 and then restores and begins a brand-new agreement period 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 Criteria Year 3. GUIDE Reprieve Service claims will not be counted toward ACO expenditures, shared savings, nor benchmarking start in 2024 for the period of the GUIDE Design.

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

Overlapping participants ought to follow GUIDE billing assistance as stated below. ACO REACH claim reductions will not use to DCMP. ACO REACH will include DCMP expenses for functions of alignment calculations. Nevertheless, GUIDE Break Service claims will not count toward ACO expenses, shared savings, or benchmarking in 2025 and for the duration of the GUIDE Model.

As of January 1, 2025, GUIDE Participants likewise taking part in ACO REACH must stop billing the Medicare Doctor Fee Schedule Providers consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Methodology Paper (PDF)). Participants participating in both models need to follow the GUIDE billing requirements in the GUIDE Participation Agreement and GUIDE Payment Methodology Paper.

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The GUIDE Individual must not bill Medicare separately for the services provided in the thorough evaluation. The detailed assessment (and any re-assessments) is covered by the DCMP. If CMS figures out the recipient is not eligible for the GUIDE Design, the GUIDE Individual can bill for a suitable Medicare-covered professional service that represents the services rendered.