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However, GUIDE Participants have the option, and are not needed, to provide respite through an adult day center or a 24-hour center. Additional GUIDE Break Services requirements and details surrounding the payment for such services are specified in the Participation Agreement. GUIDE Participants in the brand-new program track that are categorized as safeguard companies will be qualified to receive a one-time facilities payment of $75,000 (geographically adjusted by the Geographic Adjustment Aspect [GAF] to cover some of the in advance expenses of establishing a brand-new dementia care program.

The infrastructure payment is intended for companies who wish to develop new dementia care programs and require resources to start. GUIDE Participants certified as a safeguard supplier based on the proportion of their patient population that is dually eligible for Medicare and Medicaid or get the Part D low-income subsidy.

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To qualify as a GUIDE safety web supplier, a new program applicant need to have had a Medicare FFS recipient population consisted of a minimum of 36% recipients getting the Part D low-income subsidy or 33.7% recipients 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 an aligned recipient is re-assessed and designated to a brand-new tier, the GUIDE Individual will be eligible to bill the G-code for the established client payment rate associated with that tier the following month. GUIDE Participants that withdraw or are ended before the start of the 2nd performance year will be needed to pay back the entire value of their facilities payment to CMS.

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After the 2nd efficiency year, GUIDE Individuals that withdraw or are terminated from the GUIDE Design are not required to repay the infrastructure payment. The primary 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 replace fee-for-service payment for some existing Medicare Physician Charge Set Up (PFS) services, consisting of 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 design, so GUIDE Participants will continue to costs under conventional Medicare fee-for-service for all services that are not consisted of under the DCMP. Additional details, consisting of a total list of duplicative codes, is readily available in the Request for Applications (Table 8, pg. 35). CMS may include or eliminate codes gradually to reflect modifications in PFS billing codes.

The care team might include the recipient's primary care service provider, and if not, the care team is needed to determine and share details with the recipient's primary care service provider and professionals and describe the care coordination services required to manage the beneficiary's dementia and co-occurring conditions. CMS will supply GUIDE Participants data related to the performance determines that CMS uses to figure out the GUIDE Participant's performance-based change to the DCMP.GUIDE Individuals in the established program track need to be prepared to begin furnishing services under the GUIDE Model on July 1, 2024, and bill for those services throughout the Model Performance Period.

Yes, GUIDE recipient and provider overlap with the Shared Savings Program is allowed. The GUIDE Model is designed to be suitable with other CMS designs and programs that aim to enhance care and lower spending. CMS thinks targeted support for individuals with dementia and their caregivers will assist enhance population-based care outcomes in general.

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The Dementia Care Management Payment (DCMP), the per recipient per month GUIDE payment, will be consisted of in 2024 Shared Savings Program expenses. When 2024 becomes a benchmark year, DCMPs will be consisted of in Shared Savings Program benchmark computations. As an example, if an ACO is getting involved in both the GUIDE Design and the Shared Savings Program throughout Efficiency Year 2024 and after that renews and starts a new agreement duration as of January 1, 2025, that ACO would have their Shared Cost savings Program standard based upon 2022, 2023 and 2024, and would have DCMPs counted in Benchmark Year 3. GUIDE Respite 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 may take part in multiple CMS Innovation Center designs or Medicare value-based care efforts to speed up development in care shipment, lower the cost of care, and improve population health. Participants 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 Break Service claims in the REACH ACOs' overall cost of care expenses or estimation of shared savings/shared losses.

Overlapping participants ought to follow GUIDE billing guidance as set forth below. ACO REACH claim decreases will not apply to DCMP. ACO REACH will include DCMP expenditures for functions of positioning estimations. However, GUIDE Respite Service claims will not count toward ACO expenses, shared savings, or benchmarking in 2025 and for the period of the GUIDE Design.

As of January 1, 2025, GUIDE Participants also taking part in ACO REACH need to terminate billing the Medicare Doctor Fee Set up Providers 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 Participation Arrangement and GUIDE Payment Methodology Paper.

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The GUIDE Individual should not bill Medicare separately for the services supplied in the thorough assessment. The thorough evaluation (and any re-assessments) is covered by the DCMP. If CMS figures out the beneficiary is not qualified for the GUIDE Model, the GUIDE Participant can bill for a proper Medicare-covered professional service that corresponds to the services rendered.