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GUIDE Participants 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 Services requirements and information surrounding the payment for such services are specified in the Participation Contract.

The facilities payment is meant for providers who wish to develop new dementia care programs and require resources to get started. GUIDE Individuals certified as a safeguard supplier based on the proportion of their client population that is dually eligible for Medicare and Medicaid or receive the Part D low-income subsidy.

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To certify as a GUIDE safeguard service provider, a new program applicant should have had a Medicare FFS beneficiary population consisted of at least 36% beneficiaries receiving the Part D low-income aid or 33.7% recipients who are dually qualified for Medicare and Medicaid. Accepting the infrastructure 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 eligible to bill the G-code for the recognized patient 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 performance year, GUIDE Participants that withdraw or are ended from the GUIDE Design are not required to repay the infrastructure payment. The primary 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 change fee-for-service payment for some existing Medicare Physician Cost Set Up (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 Design is not a total-cost-of-care design, so GUIDE Individuals will continue to costs under traditional Medicare fee-for-service for all services that are not included under the DCMP. CMS might add or get rid of codes over time to reflect changes in PFS billing codes.

The care team might include the beneficiary's main care supplier, and if not, the care team is needed to recognize and share details with the recipient's medical care company and experts and describe the care coordination services needed to manage the beneficiary's dementia and co-occurring conditions. CMS will offer GUIDE Individuals information associated with the performance determines that CMS utilizes to identify the GUIDE Individual's performance-based change to the DCMP.GUIDE Participants in the recognized program track must be prepared to start furnishing services under the GUIDE Model on July 1, 2024, and expense for those services throughout the Model Performance Duration.

Yes, GUIDE recipient and service provider overlap with the Shared Savings Program is permitted. The GUIDE Design is created to be suitable with other CMS designs and programs that intend to improve care and reduce spending. CMS believes targeted support for individuals with dementia and their caregivers will assist improve population-based care results overall.

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As an example, if an ACO is getting involved in both the GUIDE Model and the Shared Savings Program during Efficiency Year 2024 and then renews and starts a brand-new agreement duration as of January 1, 2025, that ACO would have their Shared Savings Program standard based on 2022, 2023 and 2024, and would have DCMPs counted in Standard Year 3. GUIDE Respite Service claims will not be counted towards ACO expenditures, shared savings, nor benchmarking start in 2024 for the duration of the GUIDE Design.

GUIDE Individuals may participate in several CMS Innovation Center designs or Medicare value-based care initiatives to accelerate innovation in care shipment, minimize the expense of care, and improve population health. Individuals and beneficiaries are eligible to take part in the GUIDE Design and the ACO REACH Model. 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' overall expense of care expenses or computation of shared savings/shared losses.

Overlapping participants need to follow GUIDE billing guidance as set forth below. GUIDE Break Service claims will not count toward ACO expenditures, shared savings, or benchmarking in 2025 and for the period of the GUIDE Model.

As of January 1, 2025, GUIDE Participants also taking part in ACO REACH should stop billing the Medicare Doctor Fee Arrange Services included under the DCMP (See Display 5 in the GUIDE Payment Approach Paper (PDF)). Participants taking part in both designs should follow the GUIDE billing requirements in the GUIDE Involvement Contract and GUIDE Payment Approach Paper.

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The GUIDE Participant need to not bill Medicare separately for the services offered in the comprehensive evaluation. The thorough evaluation (and any re-assessments) is covered by the DCMP. If CMS identifies the recipient is not qualified for the GUIDE Model, the GUIDE Individual can bill for an appropriate Medicare-covered professional service that corresponds to the services rendered.