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GUIDE Participants have the alternative, and are not needed, to make offered respite through an adult day center or a 24-hour facility. Extra GUIDE Respite Services requirements and details surrounding the payment for such services are specified in the Participation Agreement.

The facilities payment is planned for companies who desire to develop brand-new dementia care programs and need resources to start. GUIDE Participants qualified as a safety net provider based on the percentage of their patient population that is dually eligible for Medicare and Medicaid or receive the Part D low-income aid.

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To certify as a GUIDE safety internet company, a brand-new program applicant should have had a Medicare FFS recipient population made up of a minimum of 36% recipients getting the Part D low-income aid or 33.7% recipients who are dually qualified for Medicare and Medicaid. Accepting the facilities payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE break services will be subject to beneficiary cost-sharing.

When an aligned recipient is re-assessed and designated to a new tier, the GUIDE Individual will be qualified to bill the G-code for the established patient payment rate associated with that tier the following month. GUIDE Individuals that withdraw or are ended before the start of the 2nd efficiency year will be required to repay the entire value of their infrastructure 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 required to pay back the infrastructure payment. The main model 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 Fee Arrange (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 model, so GUIDE Individuals will continue to bill under conventional Medicare fee-for-service for all services that are not consisted of under the DCMP. Extra 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 remove codes gradually to show modifications in PFS billing codes.

The care group might consist of the beneficiary's medical care provider, and if not, the care team is required to determine and share information with the recipient's medical care 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 information associated with the efficiency determines that CMS utilizes to figure out the GUIDE Participant's performance-based adjustment to the DCMP.GUIDE Individuals in the established program track ought to be prepared to start furnishing services under the GUIDE Design on July 1, 2024, and costs for those services throughout the Model Performance Duration.

Yes, GUIDE recipient and provider overlap with the Shared Cost savings Program is enabled. The GUIDE Design is created to be suitable with other CMS designs and programs that intend to improve care and decrease spending. CMS thinks targeted support for people with dementia and their caretakers will help enhance population-based care outcomes overall.

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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 ends up being a benchmark year, DCMPs will be consisted of in Shared Savings Program criteria estimations. As an example, if an ACO is taking part in both the GUIDE Model and the Shared Savings Program during Performance Year 2024 and after that renews and begins a new arrangement duration since 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. However, GUIDE Respite Service claims will not be counted towards ACO expenses, shared savings, nor benchmarking start in 2024 throughout of the GUIDE Model.

GUIDE Participants may participate in several CMS Development Center models or Medicare value-based care initiatives to speed up innovation in care shipment, decrease the expense of care, and enhance 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 include the Dementia Care Management Payment (DCMP) or Break Service declares in the REACH ACOs' total expense of care expenditures or computation of shared savings/shared losses.

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

Since January 1, 2025, GUIDE Participants likewise participating in ACO REACH need to cease billing the Medicare Doctor Fee Arrange Providers consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Methodology Paper (PDF)). Individuals getting involved 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 provided in the extensive evaluation. The extensive assessment (and any re-assessments) is covered by the DCMP. If CMS determines the recipient is not qualified for the GUIDE Model, the GUIDE Individual can bill for a suitable Medicare-covered expert service that represents the services rendered.