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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 facility. Additional GUIDE Respite Solutions requirements and information surrounding the payment for such services are specified in the Participation Contract. GUIDE Participants in the new program track that are categorized as safety net companies will be eligible to receive a one-time infrastructure payment of $75,000 (geographically adjusted by the Geographic Change Factor [GAF] to cover a few of the in advance costs of developing a brand-new dementia care program.

The facilities payment is intended for suppliers who want to develop new dementia care programs and need resources to get started. GUIDE Individuals certified as a security net supplier based upon the percentage of their client population that is dually qualified for Medicare and Medicaid or receive the Part D low-income aid.

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To qualify as a GUIDE safety internet provider, a new program applicant must have had a Medicare FFS recipient population made up of at least 36% recipients receiving the Part D low-income aid or 33.7% recipients who are dually qualified for Medicare and Medicaid. Accepting the facilities payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE reprieve services will undergo beneficiary cost-sharing.

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

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After the 2nd efficiency year, GUIDE Individuals that withdraw or are terminated from the GUIDE Design are not required to repay the infrastructure payment. The primary 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 replace fee-for-service payment for some existing Medicare Doctor Charge Schedule (PFS) services, including 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 model, so GUIDE Individuals 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 eliminate codes over time to show modifications in PFS billing codes.

The care group may include the beneficiary's main care company, and if not, the care team is needed to determine and share info with the beneficiary's primary care company and professionals and detail the care coordination services required to handle the recipient's dementia and co-occurring conditions. CMS will offer GUIDE Participants data connected to the efficiency determines that CMS utilizes to identify the GUIDE Individual's performance-based change to the DCMP.GUIDE Participants in the established program track ought to be prepared to start furnishing services under the GUIDE Design on July 1, 2024, and bill for those services throughout the Design Performance Period.

Yes, GUIDE beneficiary and supplier overlap with the Shared Savings Program is allowed. The GUIDE Model is created to be compatible with other CMS models and programs that intend to improve care and lower costs. CMS believes targeted assistance for individuals with dementia and their caretakers will help enhance population-based care results overall.

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The Dementia Care Management Payment (DCMP), the per beneficiary per month GUIDE payment, will be included in 2024 Shared Savings Program expenses. When 2024 ends up being a benchmark year, DCMPs will be included in Shared Cost savings Program standard estimations. As an example, if an ACO is taking part in both the GUIDE Model and the Shared Cost Savings Program during Efficiency Year 2024 and after that restores and begins a new contract period as of January 1, 2025, that ACO would have their Shared Cost savings Program benchmark based on 2022, 2023 and 2024, and would have DCMPs counted in Standard Year 3. GUIDE Reprieve Service claims will not be counted toward ACO expenditures, shared cost savings, nor benchmarking beginning in 2024 for the duration of the GUIDE Design.

GUIDE Individuals may participate in numerous CMS Innovation Center designs or Medicare value-based care efforts to speed up innovation in care shipment, minimize the cost of care, and improve population health. Individuals and beneficiaries are eligible 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 Break Service claims in the REACH ACOs' total expense of care expenditures or calculation of shared savings/shared losses.

Overlapping participants must follow GUIDE billing assistance as set forth listed below. ACO REACH claim reductions will not apply to DCMP. ACO REACH will consist of DCMP expenditures for purposes of positioning computations. However, GUIDE Respite Service claims will not count towards ACO expenditures, shared cost savings, or benchmarking in 2025 and for the period of the GUIDE Model.

As of January 1, 2025, GUIDE Individuals also getting involved in ACO REACH must discontinue billing the Medicare Doctor Charge Set up Providers consisted of under the DCMP (See Exhibition 5 in the GUIDE Payment Method Paper (PDF)). Participants participating in both models need to follow the GUIDE billing requirements in the GUIDE Involvement Agreement and GUIDE Payment Method Paper.

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