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Nevertheless, GUIDE Participants have the alternative, and are not required, to offer 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 specified in the Participation Agreement. GUIDE Individuals in the brand-new program track that are categorized as safety net providers will be eligible to get a one-time facilities payment of $75,000 (geographically changed by the Geographic Modification Element [GAF] to cover a few of the in advance costs of establishing a new dementia care program.

The infrastructure payment is planned for providers who desire to develop new dementia care programs and need resources to start. GUIDE Participants certified as a security net company based on the proportion of their client population that is dually eligible for Medicare and Medicaid or get the Part D low-income aid.

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To certify as a GUIDE safeguard company, a brand-new program candidate need to have had a Medicare FFS beneficiary population made up of a minimum of 36% recipients 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 reprieve services will undergo recipient cost-sharing.

When an aligned recipient is re-assessed and designated to a 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 2nd efficiency year will be required to pay back the entire worth of their facilities payment to CMS.

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After the second performance year, GUIDE Participants that withdraw or are ended from the GUIDE Model are not required to pay back the facilities payment. The main 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 Cost Schedule (PFS) services, consisting of 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 expense under standard Medicare fee-for-service for all services that are not included under the DCMP. Extra details, consisting of a complete list of duplicative codes, is available in the Request for Applications (Table 8, pg. 35). CMS may include or eliminate codes with time to show modifications in PFS billing codes.

The care team might include the recipient's medical care supplier, and if not, the care team is needed to identify and share info with the beneficiary's medical care provider and specialists and describe the care coordination services required to manage the beneficiary's dementia and co-occurring conditions. CMS will provide GUIDE Participants information associated with the efficiency determines that CMS uses to determine the GUIDE Individual's performance-based modification to the DCMP.GUIDE Participants in the recognized program track must be prepared to begin providing services under the GUIDE Model on July 1, 2024, and costs for those services throughout the Design Performance Duration.

Yes, GUIDE recipient and company overlap with the Shared Savings Program is allowed. The GUIDE Model is created to be compatible with other CMS models and programs that intend to improve care and decrease costs. CMS believes targeted support for people with dementia and their caregivers will assist enhance population-based care results in general.

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As an example, if an ACO is participating in both the GUIDE Model and the Shared Savings Program during Performance Year 2024 and then renews and begins a brand-new agreement duration 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 Benchmark Year 3. GUIDE Break Service claims will not be counted towards ACO expenses, shared cost savings, nor benchmarking start in 2024 for the period of the GUIDE Design.

GUIDE Participants may participate in multiple CMS Development Center designs or Medicare value-based care efforts to accelerate innovation in care delivery, decrease the expense of care, and improve population health. Individuals and beneficiaries are eligible to take part in the GUIDE Model and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not include the Dementia Care Management Payment (DCMP) or Respite Service claims in the REACH ACOs' total expense of care expenditures or calculation of shared savings/shared losses.

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

Since January 1, 2025, GUIDE Individuals also taking part in ACO REACH need to stop billing the Medicare Doctor Fee Arrange Services consisted of under the DCMP (See Exhibition 5 in the GUIDE Payment Methodology Paper (PDF)). Participants taking part in both designs should follow the GUIDE billing requirements in the GUIDE Involvement Agreement and GUIDE Payment Methodology Paper.

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The GUIDE Individual should not bill Medicare independently for the services provided in the extensive evaluation. The extensive assessment (and any re-assessments) is covered by the DCMP. If CMS figures out the recipient is not qualified for the GUIDE Design, the GUIDE Participant can bill for an appropriate Medicare-covered professional service that corresponds to the services rendered.