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GUIDE Participants have the choice, and are not required, to make readily available break through an adult day center or a 24-hour facility. Extra GUIDE Break Services requirements and information surrounding the payment for such services are specified in the Participation Arrangement.

The infrastructure payment is planned for companies who want to develop new dementia care programs and require resources to get going. 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 safeguard provider, a brand-new program applicant should have had a Medicare FFS recipient population consisted of at least 36% recipients getting the Part D low-income aid 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 reprieve services will go through beneficiary cost-sharing.

When a lined up recipient is re-assessed and designated to a new tier, the GUIDE Participant will be eligible to bill the G-code for the recognized patient payment rate associated with that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the second performance year will be needed to repay the whole worth of their infrastructure payment to CMS.

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After the 2nd efficiency year, GUIDE Individuals that withdraw or are terminated from the GUIDE Model are not needed 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 change 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 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 standard Medicare fee-for-service for all services that are not included under the DCMP. CMS may include or eliminate codes over time to reflect changes in PFS billing codes.

The care group may include the recipient's medical care supplier, and if not, the care group is required to identify and share information with the recipient's main care company and specialists and describe the care coordination services required to manage the recipient's dementia and co-occurring conditions. CMS will supply GUIDE Participants data connected to the performance measures that CMS utilizes to determine the GUIDE Participant's performance-based change to the DCMP.GUIDE Individuals in the recognized program track ought to be prepared to begin furnishing services under the GUIDE Design on July 1, 2024, and expense for those services during the Design Performance Period.

Yes, GUIDE beneficiary and company overlap with the Shared Cost savings Program is allowed. The GUIDE Design is developed to be compatible with other CMS models and programs that aim to enhance care and lower costs. CMS believes targeted assistance 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 each 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 standard estimations. As an example, if an ACO is taking part in both the GUIDE Design and the Shared Savings Program throughout Performance Year 2024 and after that renews and begins a new arrangement duration since January 1, 2025, that ACO would have their Shared Savings Program benchmark based on 2022, 2023 and 2024, and would have DCMPs counted in Standard Year 3. GUIDE Respite Service claims will not be counted toward ACO expenses, shared savings, nor benchmarking start in 2024 for the duration of the GUIDE Model.

GUIDE Individuals may get involved in multiple CMS Development Center models or Medicare value-based care efforts to accelerate innovation in care delivery, reduce the expense of care, and enhance 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 include the Dementia Care Management Payment (DCMP) or Reprieve Service claims in the REACH ACOs' overall expense of care expenditures or computation of shared savings/shared losses.

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

Since January 1, 2025, GUIDE Participants likewise taking part in ACO REACH ought to stop billing the Medicare Doctor Charge Arrange Solutions consisted of under the DCMP (See Exhibition 5 in the GUIDE Payment Approach Paper (PDF)). Participants getting involved in both designs should follow the GUIDE billing requirements in the GUIDE Involvement Agreement and GUIDE Payment Approach Paper.

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The GUIDE Individual must not bill Medicare separately for the services offered in the comprehensive evaluation. The thorough evaluation (and any re-assessments) is covered by the DCMP. If CMS identifies the recipient is not qualified for the GUIDE Model, the GUIDE Individual can bill for a proper Medicare-covered professional service that represents the services rendered.