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However, GUIDE Individuals have the alternative, and are not needed, to provide respite through an adult day center or a 24-hour center. Additional GUIDE Respite Solutions requirements and details surrounding the payment for such services are specified in the Involvement Contract. GUIDE Participants in the new program track that are categorized as security net companies 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 upfront expenses of establishing a brand-new dementia care program.

The infrastructure payment is intended for companies who wish to establish new dementia care programs and need resources to begin. GUIDE Participants qualified as a security net provider based on the proportion of their client 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 internet supplier, a new program candidate should have had a Medicare FFS beneficiary population consisted of a minimum of 36% beneficiaries getting the Part D low-income subsidy or 33.7% recipients who are dually eligible for Medicare and Medicaid. Accepting the infrastructure payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE respite services will be subject to beneficiary cost-sharing.

When an aligned beneficiary is re-assessed and designated to a new tier, the GUIDE Individual will be eligible to bill the G-code for the established client 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 repay the whole value of their facilities payment to CMS.

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After the 2nd efficiency year, GUIDE Participants that withdraw or are ended from the GUIDE Design are not needed to pay back 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 change fee-for-service payment for some existing Medicare Doctor 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 expense under traditional Medicare fee-for-service for all services that are not consisted of under the DCMP. CMS may include or get rid of codes over time to show modifications in PFS billing codes.

The care group might consist of the recipient's main care company, and if not, the care group is required to identify and share details with the beneficiary's medical care service provider and experts and detail the care coordination services required to manage the recipient's dementia and co-occurring conditions. CMS will provide GUIDE Individuals data related to the efficiency determines that CMS utilizes to identify the GUIDE Participant's performance-based change to the DCMP.GUIDE Individuals in the recognized program track ought to be prepared to begin providing services under the GUIDE Design on July 1, 2024, and bill for those services throughout the Design Efficiency Period.

Yes, GUIDE recipient and provider overlap with the Shared Savings Program is allowed. The GUIDE Model is developed to be compatible with other CMS designs and programs that intend to improve care and decrease spending. CMS believes targeted support for individuals with dementia and their caretakers will help improve population-based care results overall.

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As an example, if an ACO is taking part in both the GUIDE Design and the Shared Cost Savings Program throughout Performance Year 2024 and then renews and starts a brand-new agreement duration as of January 1, 2025, that ACO would have their Shared Cost savings Program criteria 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 expenses, shared savings, nor benchmarking beginning in 2024 for the period of the GUIDE Design.

GUIDE Individuals may get involved in several CMS Innovation Center designs or Medicare value-based care efforts to accelerate innovation in care delivery, lower the cost of care, and improve population health. Individuals and recipients are qualified to take part in the GUIDE Design and the ACO REACH Model. For the rest of CY 2024, ACO REACH will not consist of the Dementia Care Management Payment (DCMP) or Reprieve Service claims in the REACH ACOs' overall expense of care expenditures or calculation of shared savings/shared losses.

Overlapping participants should follow GUIDE billing guidance as set forth listed below. ACO REACH claim decreases will not apply to DCMP. ACO REACH will consist of DCMP expenses for purposes of alignment computations. However, GUIDE Break Service claims will not count toward ACO expenses, shared savings, or benchmarking in 2025 and for the duration of the GUIDE Model.

As of January 1, 2025, GUIDE Participants also getting involved in ACO REACH must discontinue billing the Medicare Doctor Cost Arrange Providers included under the DCMP (See Display 5 in the GUIDE Payment Method Paper (PDF)). Participants taking part in both designs should follow the GUIDE billing requirements in the GUIDE Participation Contract and GUIDE Payment Methodology Paper.

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The GUIDE Individual should not bill Medicare independently for the services supplied in the thorough evaluation. The extensive assessment (and any re-assessments) is covered by the DCMP. If CMS determines the beneficiary is not eligible for the GUIDE Model, the GUIDE Participant can bill for a suitable Medicare-covered expert service that represents the services rendered.