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GUIDE Individuals have the alternative, and are not needed, to make available respite through an adult day center or a 24-hour facility. Additional GUIDE Respite Services requirements and information surrounding the payment for such services are defined in the Involvement Contract.

The infrastructure payment is intended for companies who wish to develop brand-new dementia care programs and require resources to start. GUIDE Participants certified as a safety net provider based on the proportion of their patient population that is dually eligible for Medicare and Medicaid or receive the Part D low-income subsidy.

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To certify as a GUIDE security net supplier, a brand-new program applicant should have had a Medicare FFS recipient population consisted 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 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 appointed to a brand-new tier, the GUIDE Individual will be qualified to bill the G-code for the established client payment rate associated with that tier the following month. GUIDE Individuals that withdraw or are terminated before the start of the 2nd performance year will be needed to pay back the whole value of their facilities payment to CMS.

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After the 2nd efficiency year, GUIDE Participants that withdraw or are terminated from the GUIDE Design 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 change 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 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 bill under conventional Medicare fee-for-service for all services that are not consisted of under the DCMP. Extra info, consisting of a complete list of duplicative codes, is available in the Request for Applications (Table 8, pg. 35). CMS may include or remove codes gradually to show changes in PFS billing codes.

The care group may consist of the recipient's medical care service provider, and if not, the care team is needed to determine and share info with the recipient's primary care supplier and experts and lay out the care coordination services needed to handle the recipient's dementia and co-occurring conditions. CMS will supply GUIDE Participants data associated with the efficiency measures that CMS uses to identify 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 costs for those services throughout the Model Performance Period.

Yes, GUIDE beneficiary and service provider overlap with the Shared Savings Program is enabled. The GUIDE Model is designed to be suitable with other CMS models and programs that aim to enhance care and lower spending. CMS thinks targeted assistance for people with dementia and their caretakers will help 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 consisted of in 2024 Shared Savings Program expenditures. When 2024 ends up being a benchmark year, DCMPs will be included in Shared Savings Program benchmark calculations. As an example, if an ACO is taking part in both the GUIDE Model and the Shared Cost Savings Program throughout Performance Year 2024 and then restores and starts a new contract 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 Standard Year 3. GUIDE Break Service claims will not be counted toward ACO expenses, shared savings, nor benchmarking beginning in 2024 for the period of the GUIDE Model.

GUIDE Participants may participate in multiple CMS Innovation Center models or Medicare value-based care initiatives to speed up innovation in care delivery, lower the cost of care, and improve population health. Participants and recipients are eligible to take part in the GUIDE Model and the ACO REACH Model. For the rest of CY 2024, ACO REACH will not consist of the Dementia Care Management Payment (DCMP) or Break Service declares in the REACH ACOs' total cost of care expenses or computation of shared savings/shared losses.

Overlapping participants must follow GUIDE billing guidance as set forth listed below. 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 likewise taking part in ACO REACH need to stop billing the Medicare Doctor Cost Schedule Providers 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 Method Paper.

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The GUIDE Participant need to not bill Medicare separately for the services supplied in the comprehensive assessment. The comprehensive assessment (and any re-assessments) is covered by the DCMP. If CMS determines the beneficiary is not eligible for the GUIDE Model, the GUIDE Individual can bill for a proper Medicare-covered professional service that corresponds to the services rendered.