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GUIDE Participants have the option, 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 details surrounding the payment for such services are specified in the Participation Agreement.

The infrastructure payment is meant for suppliers who wish to establish brand-new dementia care programs and need resources to begin. GUIDE Participants certified as a safeguard provider based upon the proportion of their patient population that is dually qualified for Medicare and Medicaid or get the Part D low-income aid.

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To certify as a GUIDE safeguard supplier, a brand-new program candidate must have had a Medicare FFS beneficiary population comprised of a minimum of 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 recipient cost-sharing.

When an aligned beneficiary is re-assessed and assigned to a new tier, the GUIDE Participant will be eligible to bill the G-code for the established client payment rate related to that tier the following month. GUIDE Participants that withdraw or are ended before the start of the second performance year will be needed to repay the whole value of their infrastructure payment to CMS.

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After the 2nd performance year, GUIDE Participants that withdraw or are ended from the GUIDE Model 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 change fee-for-service payment for some existing Medicare Physician Cost Set Up (PFS) services, including persistent 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 Individuals will continue to costs under traditional Medicare fee-for-service for all services that are not included under the DCMP. CMS may include or remove codes over time to reflect modifications in PFS billing codes.

The care group may consist of the recipient's medical care supplier, and if not, the care team is needed to recognize and share information with the beneficiary's medical care service provider and professionals and describe the care coordination services needed to manage the recipient's dementia and co-occurring conditions. CMS will offer GUIDE Individuals data related to the efficiency measures that CMS utilizes to figure out the GUIDE Participant's performance-based adjustment to the DCMP.GUIDE Participants in the established program track need to be prepared to begin providing services under the GUIDE Design 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 Model is developed to be compatible with other CMS models and programs that aim to improve care and decrease spending. CMS believes targeted assistance for individuals with dementia and their caretakers will assist enhance population-based care outcomes in general.

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The Dementia Care Management Payment (DCMP), the per beneficiary per month GUIDE payment, will be consisted of in 2024 Shared Cost savings Program expenses. When 2024 becomes a benchmark year, DCMPs will be consisted of in Shared Cost savings Program standard estimations. As an example, if an ACO is taking part in both the GUIDE Design and the Shared Savings Program during 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. However, GUIDE Reprieve Service claims will not be counted toward ACO expenses, shared savings, nor benchmarking beginning in 2024 for the duration of the GUIDE Design.

GUIDE Individuals might take part in several CMS Development Center designs or Medicare value-based care initiatives to speed up development in care delivery, reduce the expense of care, and enhance population health. Participants and recipients are eligible to get involved 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 declares in the REACH ACOs' overall cost of care expenditures or estimation of shared savings/shared losses.

Overlapping participants should follow GUIDE billing assistance as set forth listed below. ACO REACH claim reductions will not use to DCMP. ACO REACH will include DCMP expenditures for functions of alignment estimations. Nevertheless, GUIDE Respite Service claims will not count toward ACO expenses, shared savings, or benchmarking in 2025 and throughout of the GUIDE Design.

As of January 1, 2025, GUIDE Individuals also taking part in ACO REACH should terminate billing the Medicare Doctor Cost Arrange Providers consisted of under the DCMP (See Exhibition 5 in the GUIDE Payment Approach Paper (PDF)). Individuals taking part in both models should follow the GUIDE billing requirements in the GUIDE Participation Contract and GUIDE Payment Method Paper.

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The GUIDE Individual must not bill Medicare independently for the services supplied in the comprehensive evaluation. The thorough assessment (and any re-assessments) is covered by the DCMP. If CMS determines the recipient is not eligible for the GUIDE Design, the GUIDE Individual can bill for an appropriate Medicare-covered expert service that represents the services rendered.