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GUIDE Individuals have the option, and are not required, to make offered break through an adult day center or a 24-hour center. Extra GUIDE Respite Providers requirements and information surrounding the payment for such services are specified in the Participation Agreement.

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

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To qualify as a GUIDE safeguard provider, a new program candidate need to have had a Medicare FFS beneficiary population made up of at least 36% recipients receiving the Part D low-income aid 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 break services will go through recipient cost-sharing.

When a lined up recipient is re-assessed and assigned to a new tier, the GUIDE Individual will be eligible to bill the G-code for the established patient payment rate connected with that tier the following month. GUIDE Individuals that withdraw or are ended before the start of the 2nd efficiency 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 Individuals that withdraw or are ended from the GUIDE Model are not required to repay the facilities payment. The main 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 Physician Cost Set Up (PFS) services, including persistent care management and primary 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 standard Medicare fee-for-service for all services that are not included under the DCMP. Extra info, consisting of a complete list of duplicative codes, is readily available in the Ask for Applications (Table 8, pg. 35). CMS might include or eliminate codes with time to show changes in PFS billing codes.

The care group might consist of the recipient's medical care supplier, and if not, the care team is required to identify and share information with the beneficiary's main care company and professionals and describe the care coordination services needed to manage the beneficiary's dementia and co-occurring conditions. CMS will supply GUIDE Individuals data related to the efficiency determines that CMS uses to figure out the GUIDE Participant's performance-based change to the DCMP.GUIDE Participants in the recognized program track should be prepared to begin providing services under the GUIDE Model on July 1, 2024, and expense for those services throughout the Design Performance Duration.

Yes, GUIDE beneficiary and company overlap with the Shared Savings Program is enabled. The GUIDE Design is designed to be compatible with other CMS designs and programs that aim to enhance care and decrease spending. CMS believes targeted support for people with dementia and their caregivers will help improve population-based care results overall.

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As an example, if an ACO is participating in both the GUIDE Model and the Shared Savings Program throughout Efficiency Year 2024 and then restores and begins a new contract duration as of January 1, 2025, that ACO would have their Shared Cost savings Program standard based on 2022, 2023 and 2024, and would have DCMPs counted in Benchmark Year 3. GUIDE Reprieve Service claims will not be counted toward ACO expenditures, shared savings, nor benchmarking beginning in 2024 for the duration of the GUIDE Design.

GUIDE Participants might take part in several CMS Development Center models or Medicare value-based care efforts to accelerate innovation in care shipment, reduce the expense of care, and enhance population health. Individuals and recipients are qualified to participate in the GUIDE Model and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not consist of the Dementia Care Management Payment (DCMP) or Respite Service claims in the REACH ACOs' overall expense of care expenses or estimation of shared savings/shared losses.

Overlapping individuals should follow GUIDE billing guidance as set forth below. GUIDE Break Service claims will not count towards ACO expenditures, shared cost savings, or benchmarking in 2025 and for the duration of the GUIDE Design.

As of January 1, 2025, GUIDE Individuals likewise taking part in ACO REACH ought to cease billing the Medicare Doctor Cost Set up Solutions consisted of under the DCMP (See Exhibition 5 in the GUIDE Payment Method Paper (PDF)). Participants taking part in both models need to follow the GUIDE billing requirements in the GUIDE Involvement Agreement and GUIDE Payment Methodology Paper.

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The GUIDE Individual must not bill Medicare separately for the services supplied in the comprehensive evaluation. The detailed evaluation (and any re-assessments) is covered by the DCMP. If CMS identifies the beneficiary is not eligible for the GUIDE Design, the GUIDE Individual can bill for a proper Medicare-covered professional service that corresponds to the services rendered.