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GUIDE Individuals have the option, and are not needed, to make readily available break through an adult day center or a 24-hour center. Extra GUIDE Respite Providers requirements and details surrounding the payment for such services are specified in the Involvement Agreement. GUIDE Participants in the new program track that are categorized as safeguard service providers will be eligible to receive a one-time facilities payment of $75,000 (geographically changed by the Geographic Adjustment 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 want to establish brand-new dementia care programs and need resources to begin. GUIDE Individuals certified as a security net supplier based on the proportion of their patient population that is dually eligible for Medicare and Medicaid or get the Part D low-income aid.

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To qualify as a GUIDE safeguard service provider, a brand-new program candidate must have had a Medicare FFS beneficiary population consisted of a minimum of 36% beneficiaries getting the Part D low-income aid or 33.7% beneficiaries who are dually qualified for Medicare and Medicaid. Accepting the infrastructure payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE break services will be subject to recipient cost-sharing.

When a lined up beneficiary is re-assessed and appointed to a brand-new tier, the GUIDE Individual will be qualified to bill the G-code for the recognized patient payment rate related to that tier the following month. GUIDE Participants that withdraw or are ended before the start of the 2nd efficiency year will be required to pay back the entire value of their infrastructure payment to CMS.

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After the second efficiency year, GUIDE Participants that withdraw or are terminated from the GUIDE Design are not needed to repay 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 replace fee-for-service payment for some existing Medicare Doctor Fee Set Up (PFS) services, consisting of persistent care management and principal 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 expense under conventional 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 offered in the Ask for Applications (Table 8, pg. 35). CMS may include or remove codes in time to show modifications in PFS billing codes.

The care team might consist of the recipient's main care service provider, and if not, the care group is required to identify and share information with the recipient's main care provider and professionals and detail 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 measures that CMS uses to figure out the GUIDE Participant's performance-based change to the DCMP.GUIDE Individuals in the recognized program track should be prepared to begin providing services under the GUIDE Model on July 1, 2024, and costs for those services during the Model Efficiency Duration.

Yes, GUIDE recipient and service provider 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 decrease spending. CMS thinks targeted assistance for people with dementia and their caregivers will assist improve 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 throughout Performance Year 2024 and then restores and starts a brand-new contract period as of January 1, 2025, that ACO would have their Shared Cost savings Program standard 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 expenses, shared cost savings, nor benchmarking start in 2024 for the duration of the GUIDE Design.

GUIDE Participants may get involved in multiple CMS Development Center designs or Medicare value-based care efforts to accelerate development in care delivery, lower the expense of care, and improve population health. Participants and beneficiaries are eligible to take part in the GUIDE Model and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not consist of the Dementia Care Management Payment (DCMP) or Reprieve Service claims in the REACH ACOs' total cost of care expenses or computation of shared savings/shared losses.

Overlapping individuals should follow GUIDE billing assistance as set forth below. ACO REACH claim decreases will not use to DCMP. ACO REACH will consist of DCMP expenses for purposes of positioning computations. GUIDE Respite Service claims will not count towards ACO expenses, shared savings, or benchmarking in 2025 and for the period of the GUIDE Model.

Since January 1, 2025, GUIDE Participants also taking part in ACO REACH must discontinue billing the Medicare Physician Charge Schedule Services consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Method Paper (PDF)). Individuals taking part in both designs should follow the GUIDE billing requirements in the GUIDE Participation Arrangement and GUIDE Payment Method Paper.

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The GUIDE Participant should not bill Medicare separately for the services offered in the thorough assessment. The extensive assessment (and any re-assessments) is covered by the DCMP. If CMS figures out the recipient is not eligible for the GUIDE Model, the GUIDE Participant can bill for a proper Medicare-covered professional service that corresponds to the services rendered.