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GUIDE Individuals have the option, and are not required, to make offered respite through an adult day center or a 24-hour facility. Additional GUIDE Break Services requirements and details surrounding the payment for such services are defined in the Participation Contract.

The facilities payment is intended for service providers who want to establish brand-new dementia care programs and need resources to get going. GUIDE Individuals certified as a safeguard supplier 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 qualify as a GUIDE security internet company, a brand-new program applicant must have had a Medicare FFS beneficiary population comprised of at least 36% beneficiaries receiving the Part D low-income subsidy 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 break services will undergo recipient cost-sharing.

When a lined up beneficiary is re-assessed and designated to a new tier, the GUIDE Participant will be eligible to bill the G-code for the established patient payment rate associated with that tier the following month. GUIDE Individuals that withdraw or are ended before the start of the 2nd performance year will be needed 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 Model are not needed to repay the infrastructure 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 replace fee-for-service payment for some existing Medicare Doctor Fee Arrange (PFS) services, including chronic care management and primary care management, transitional care management, advance care preparation, 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. CMS might add or remove codes over time to show changes in PFS billing codes.

The care group may consist of the recipient's primary care company, and if not, the care group is required to recognize and share info with the recipient's primary care supplier and professionals and detail the care coordination services needed to handle the beneficiary's dementia and co-occurring conditions. CMS will offer GUIDE Individuals data related to the efficiency determines that CMS uses to determine the GUIDE Participant's performance-based modification to the DCMP.GUIDE Individuals in the recognized program track should be prepared to begin furnishing services under the GUIDE Model on July 1, 2024, and costs for those services during the Design Performance Duration.

Yes, GUIDE recipient and provider overlap with the Shared Savings Program is enabled. The GUIDE Model is designed to be suitable with other CMS models and programs that intend to improve care and lower costs. CMS thinks targeted assistance for people with dementia and their caregivers will assist improve population-based care outcomes overall.

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As an example, if an ACO is getting involved in both the GUIDE Design and the Shared Savings Program throughout Performance Year 2024 and then 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 Criteria Year 3. GUIDE Reprieve Service claims will not be counted toward ACO expenses, shared cost savings, nor benchmarking beginning in 2024 for the duration of the GUIDE Design.

GUIDE Individuals may take part in numerous CMS Innovation Center models or Medicare value-based care efforts to accelerate development in care delivery, lower the expense of care, and improve population health. Participants and beneficiaries are qualified 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 Respite Service claims in the REACH ACOs' total expense of care expenditures or estimation of shared savings/shared losses.

Overlapping individuals need to follow GUIDE billing assistance as set forth listed below. GUIDE Respite Service claims will not count toward ACO expenses, shared cost savings, or benchmarking in 2025 and for the period of the GUIDE Model.

Since January 1, 2025, GUIDE Individuals likewise taking part in ACO REACH must discontinue billing the Medicare Doctor Charge Arrange Services included under the DCMP (See Exhibit 5 in the GUIDE Payment Approach Paper (PDF)). Individuals taking part in both designs must follow the GUIDE billing requirements in the GUIDE Involvement Contract and GUIDE Payment Method Paper.

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The GUIDE Individual need to not bill Medicare separately for the services provided in the thorough assessment. The extensive evaluation (and any re-assessments) is covered by the DCMP. If CMS determines the recipient is not eligible for the GUIDE Design, the GUIDE Participant can bill for a proper Medicare-covered expert service that corresponds to the services rendered.