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GUIDE Participants have the option, and are not needed, to make offered reprieve through an adult day center or a 24-hour facility. Extra GUIDE Respite Services requirements and information surrounding the payment for such services are specified in the Participation Arrangement.

The infrastructure payment is planned for providers who wish to develop brand-new dementia care programs and need resources to get started. GUIDE Participants qualified as a safeguard company based upon the percentage of their patient population that is dually eligible for Medicare and Medicaid or get the Part D low-income subsidy.

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To qualify as a GUIDE safeguard company, a new program candidate should have had a Medicare FFS beneficiary population consisted of a minimum of 36% beneficiaries 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 respite services will go through recipient cost-sharing.

When an aligned beneficiary is re-assessed and assigned to a new tier, the GUIDE Individual 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 ended before the start of the second performance year will be required to repay the whole worth of their facilities payment to CMS.

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After the second efficiency year, GUIDE Individuals that withdraw or are terminated from the GUIDE Design are not required to repay the facilities payment. The main design 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 Charge Schedule (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 Participants will continue to bill under standard Medicare fee-for-service for all services that are not included under the DCMP. CMS might add or remove codes over time to show changes in PFS billing codes.

The care team might consist of the recipient's primary care company, and if not, the care group is required to determine and share information with the beneficiary's medical care supplier and experts and lay out the care coordination services required to handle the recipient's dementia and co-occurring conditions. CMS will offer GUIDE Individuals data related to the performance measures that CMS uses to determine the GUIDE Individual's performance-based change to the DCMP.GUIDE Individuals in the recognized program track should 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 beneficiary and supplier overlap with the Shared Savings Program is allowed. The GUIDE Design is designed to be suitable with other CMS models and programs that intend to improve care and minimize spending. CMS believes targeted assistance for individuals with dementia and their caregivers will help enhance population-based care outcomes in general.

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As an example, if an ACO is taking part in both the GUIDE Model and the Shared Cost Savings Program throughout Performance Year 2024 and then restores and begins a brand-new agreement period 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 Benchmark Year 3. GUIDE Break Service claims will not be counted towards ACO expenses, shared savings, nor benchmarking start in 2024 for the period of the GUIDE Design.

GUIDE Individuals may participate in multiple CMS Innovation Center designs or Medicare value-based care initiatives to speed up innovation in care shipment, lower the cost of care, and enhance population health. Participants and recipients are qualified to take part in the GUIDE Design and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not consist of the Dementia Care Management Payment (DCMP) or Respite Service claims in the REACH ACOs' overall cost of care expenses or calculation of shared savings/shared losses.

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

Since January 1, 2025, GUIDE Participants likewise taking part in ACO REACH need to cease billing the Medicare Physician Charge Set up Services included under the DCMP (See Display 5 in the GUIDE Payment Approach Paper (PDF)). Individuals taking part in both designs must follow the GUIDE billing requirements in the GUIDE Involvement Arrangement and GUIDE Payment Methodology Paper.

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