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GUIDE Participants have the alternative, and are not required, to make offered respite through an adult day center or a 24-hour center. Additional GUIDE Respite Solutions requirements and details surrounding the payment for such services are specified in the Involvement Contract.

The infrastructure payment is intended for service providers who desire to develop new dementia care programs and require resources to get started. GUIDE Individuals qualified as a security net supplier based upon the percentage of their patient population that is dually qualified for Medicare and Medicaid or get the Part D low-income subsidy.

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To certify as a GUIDE safeguard company, a brand-new program applicant must have had a Medicare FFS recipient population made up of a minimum of 36% beneficiaries receiving the Part D low-income aid or 33.7% beneficiaries who are dually qualified for Medicare and Medicaid. Accepting the facilities 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 designated to a brand-new tier, the GUIDE Participant will be qualified to bill the G-code for the established 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 needed to repay the whole value of their facilities payment to CMS.

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After the 2nd performance year, GUIDE Participants that withdraw or are terminated from the GUIDE Design are not required to repay the infrastructure payment. The primary design payment under the GUIDE Model 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 Doctor Charge Schedule (PFS) services, consisting of persistent 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 Individuals will continue to costs under standard Medicare fee-for-service for all services that are not included under the DCMP. Additional details, including a complete list of duplicative codes, is available in the Ask for Applications (Table 8, pg. 35). CMS might include or eliminate codes gradually to show modifications in PFS billing codes.

The care group may consist of the recipient's medical care service provider, and if not, the care group is required to recognize and share details with the beneficiary's medical care service provider and specialists and describe the care coordination services needed to handle the recipient's dementia and co-occurring conditions. CMS will supply GUIDE Participants data associated with the performance measures that CMS uses to determine the GUIDE Individual's performance-based modification to the DCMP.GUIDE Participants in the recognized program track need to be prepared to start furnishing services under the GUIDE Design on July 1, 2024, and expense for those services throughout the Design Efficiency Period.

Yes, GUIDE beneficiary and provider overlap with the Shared Cost savings Program is allowed. The GUIDE Model is created to be suitable with other CMS models and programs that intend to improve care and lower spending. CMS believes targeted support for people with dementia and their caretakers will assist improve population-based care outcomes overall.

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The Dementia Care Management Payment (DCMP), the per recipient monthly GUIDE payment, will be included 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 Design and the Shared Savings Program during Efficiency Year 2024 and then restores and starts a new contract period as of January 1, 2025, that ACO would have their Shared Savings Program benchmark based upon 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 duration of the GUIDE Model.

GUIDE Participants might take part in numerous CMS Innovation Center models or Medicare value-based care initiatives to accelerate development in care shipment, minimize the expense of care, and enhance population health. Individuals and beneficiaries are eligible to take part 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 calculation of shared savings/shared losses.

Overlapping participants ought to follow GUIDE billing assistance as set forth below. ACO REACH claim decreases will not use to DCMP. ACO REACH will consist of DCMP expenses for functions of positioning computations. Nevertheless, GUIDE Respite Service claims will not count towards ACO expenses, shared savings, or benchmarking in 2025 and for the period of the GUIDE Design.

As of January 1, 2025, GUIDE Individuals also participating in ACO REACH should stop billing the Medicare Doctor Charge Set up Providers included under the DCMP (See Exhibit 5 in the GUIDE Payment Approach Paper (PDF)). Individuals taking part 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 independently for the services supplied in the detailed evaluation. The detailed evaluation (and any re-assessments) is covered by the DCMP. If CMS identifies the recipient is not qualified for the GUIDE Model, the GUIDE Participant can bill for an appropriate Medicare-covered professional service that corresponds to the services rendered.