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GUIDE Individuals have the option, and are not needed, to make available respite through an adult day center or a 24-hour center. Extra GUIDE Reprieve Providers requirements and information surrounding the payment for such services are defined in the Involvement Arrangement. GUIDE Participants in the new program track that are categorized as safeguard providers will be eligible to get a one-time infrastructure payment of $75,000 (geographically changed by the Geographic Change Factor [GAF] to cover a few of the in advance costs of establishing a brand-new dementia care program.

The infrastructure payment is meant for suppliers who wish to establish new dementia care programs and need resources to begin. GUIDE Individuals certified as a safety net service provider based upon the proportion 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 safety net supplier, a brand-new program candidate must have had a Medicare FFS beneficiary population consisted of at least 36% beneficiaries getting the Part D low-income subsidy or 33.7% beneficiaries who are dually eligible for Medicare and Medicaid. Accepting the facilities payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE respite services will go through beneficiary cost-sharing.

When an aligned beneficiary is re-assessed and appointed to a new tier, the GUIDE Individual will be qualified to bill the G-code for the established patient payment rate connected with that tier the following month. GUIDE Participants that withdraw or are ended before the start of the second performance year will be required to pay back the whole worth of their facilities payment to CMS.

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After the second performance year, GUIDE Participants that withdraw or are terminated from the GUIDE Model are not needed 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 replace fee-for-service payment for some existing Medicare Doctor Charge Schedule (PFS) services, including persistent care management and principal 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 design, so GUIDE Individuals will continue to bill under conventional Medicare fee-for-service for all services that are not included under the DCMP. Extra info, consisting of a total list of duplicative codes, is readily available in the Request for Applications (Table 8, pg. 35). CMS might add or remove codes over time to reflect changes in PFS billing codes.

The care group might consist of the beneficiary's medical care service provider, and if not, the care group is required to determine and share details with the beneficiary's primary care company and professionals and lay out the care coordination services needed to handle the beneficiary's dementia and co-occurring conditions. CMS will supply GUIDE Individuals data connected to the performance measures that CMS utilizes to figure out the GUIDE Participant's performance-based adjustment to the DCMP.GUIDE Individuals in the established program track should be prepared to start providing services under the GUIDE Design on July 1, 2024, and bill for those services throughout the Model Efficiency Duration.

Yes, GUIDE recipient and service provider overlap with the Shared Cost savings Program is permitted. The GUIDE Design is created to be suitable with other CMS designs and programs that intend to improve care and lower costs. CMS thinks targeted assistance for people with dementia and their caregivers will help improve population-based care results overall.

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The Dementia Care Management Payment (DCMP), the per recipient per month GUIDE payment, will be included in 2024 Shared Cost savings Program expenditures. When 2024 ends up being a benchmark year, DCMPs will be included in Shared Cost savings Program criteria estimations. 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 renews and starts a brand-new agreement period as of January 1, 2025, that ACO would have their Shared Cost savings Program benchmark based upon 2022, 2023 and 2024, and would have DCMPs counted in Criteria Year 3. However, GUIDE Break Service claims will not be counted toward ACO expenses, shared savings, nor benchmarking beginning in 2024 for the period of the GUIDE Design.

GUIDE Participants may take part in multiple CMS Innovation Center designs or Medicare value-based care initiatives to speed up innovation in care shipment, minimize the cost of care, and improve population health. Individuals and recipients are qualified to get involved in the GUIDE Model and the ACO REACH Model. For the rest of CY 2024, ACO REACH will not include the Dementia Care Management Payment (DCMP) or Reprieve Service claims in the REACH ACOs' total expense of care expenses or computation of shared savings/shared losses.

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

Since January 1, 2025, GUIDE Individuals likewise taking part in ACO REACH ought to cease billing the Medicare Physician Cost Arrange Solutions included under the DCMP (See Exhibit 5 in the GUIDE Payment Approach Paper (PDF)). Participants taking part in both models should follow the GUIDE billing requirements in the GUIDE Participation Agreement and GUIDE Payment Methodology Paper.

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