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GUIDE Individuals have the option, and are not needed, to make available reprieve through an adult day center or a 24-hour facility. Additional GUIDE Reprieve Solutions requirements and information surrounding the payment for such services are defined in the Involvement Contract. GUIDE Individuals in the new program track that are categorized as safety net companies will be qualified 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 facilities payment is intended for service providers who want to establish new dementia care programs and need resources to start. GUIDE Participants qualified as a safeguard provider based upon the percentage of their client 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 provider, a new program applicant must have had a Medicare FFS recipient population consisted of a minimum of 36% beneficiaries receiving the Part D low-income subsidy 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 respite services will be subject to beneficiary cost-sharing.

When a lined up beneficiary is re-assessed and assigned to a brand-new tier, the GUIDE Participant will be qualified to bill the G-code for the recognized client payment rate associated with that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the 2nd efficiency year will be required to pay back the whole value of their facilities payment to CMS.

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After the second performance year, GUIDE Individuals that withdraw or are ended from the GUIDE Design are not needed to repay the infrastructure payment. The primary model 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 Physician Fee Arrange (PFS) services, including chronic care management and primary 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 costs under standard Medicare fee-for-service for all services that are not consisted of under the DCMP. Additional information, including a total list of duplicative codes, is offered in the Demand for Applications (Table 8, pg. 35). CMS may include or eliminate codes gradually to reflect modifications in PFS billing codes.

The care group might include 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 provider and specialists and detail the care coordination services needed to manage the beneficiary's dementia and co-occurring conditions. CMS will provide GUIDE Participants data associated with the performance determines that CMS utilizes to figure out the GUIDE Participant's performance-based change to the DCMP.GUIDE Individuals in the established program track should be prepared to begin providing services under the GUIDE Design on July 1, 2024, and bill for those services throughout the Model Efficiency 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 aim to enhance care and lower costs. CMS believes targeted assistance for individuals with dementia and their caretakers will help improve population-based care results in general.

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The Dementia Care Management Payment (DCMP), the per beneficiary each month GUIDE payment, will be consisted of in 2024 Shared Cost savings Program expenses. When 2024 ends up being a benchmark year, DCMPs will be included in Shared Savings Program benchmark computations. As an example, if an ACO is taking part in both the GUIDE Model and the Shared Savings Program throughout Efficiency Year 2024 and after that restores and starts a new contract period since January 1, 2025, that ACO would have their Shared Savings Program criteria based upon 2022, 2023 and 2024, and would have DCMPs counted in Criteria Year 3. GUIDE Break Service claims will not be counted toward ACO expenditures, shared cost savings, nor benchmarking start in 2024 for the duration of the GUIDE Design.

GUIDE Individuals might get involved in numerous CMS Innovation Center models or Medicare value-based care initiatives to accelerate development in care shipment, minimize the cost of care, and improve population health. Individuals and recipients are eligible to get involved in the GUIDE Model 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 ought to follow GUIDE billing guidance as set forth below. ACO REACH claim decreases will not use to DCMP. ACO REACH will consist of DCMP expenditures for functions of alignment computations. GUIDE Respite Service claims will not count towards ACO expenses, shared cost savings, or benchmarking in 2025 and for the period of the GUIDE Model.

As of January 1, 2025, GUIDE Participants also getting involved in ACO REACH need to stop billing the Medicare Physician Charge Arrange Providers consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Methodology Paper (PDF)). Individuals taking part in both models should follow the GUIDE billing requirements in the GUIDE Participation Agreement and GUIDE Payment Methodology Paper.

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The GUIDE Participant need to not bill Medicare independently for the services offered in the extensive assessment. The detailed assessment (and any re-assessments) is covered by the DCMP. If CMS figures out the recipient is not qualified for the GUIDE Model, the GUIDE Participant can bill for an appropriate Medicare-covered expert service that represents the services rendered.