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GUIDE Participants have the alternative, and are not needed, to make available break through an adult day center or a 24-hour center. Additional GUIDE Respite Providers requirements and information surrounding the payment for such services are specified in the Involvement Arrangement.

The infrastructure payment is meant for providers who wish to establish brand-new dementia care programs and need resources to get begun. GUIDE Individuals certified as a security net provider based upon the proportion of their client population that is dually qualified for Medicare and Medicaid or receive the Part D low-income aid.

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To certify as a GUIDE safeguard supplier, a brand-new program candidate should have had a Medicare FFS beneficiary population consisted of at least 36% beneficiaries receiving the Part D low-income subsidy or 33.7% beneficiaries 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 beneficiary is re-assessed and appointed to a brand-new tier, the GUIDE Individual will be eligible to bill the G-code for the established client payment rate related to that tier the following month. GUIDE Participants that withdraw or are ended before the start of the second efficiency year will be required to repay the whole value of their facilities payment to CMS.

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After the 2nd performance year, GUIDE Participants that withdraw or are ended from the GUIDE Model are not required to pay back the facilities 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 Arrange (PFS) services, consisting of 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 expense under conventional Medicare fee-for-service for all services that are not included under the DCMP. CMS may include or remove codes over time to show modifications in PFS billing codes.

The care group may include the beneficiary's medical care provider, and if not, the care group is needed to determine and share details with the recipient's medical care service provider and experts and outline the care coordination services required to handle the recipient's dementia and co-occurring conditions. CMS will provide GUIDE Participants information connected to the performance measures that CMS uses to determine the GUIDE Individual's performance-based modification to the DCMP.GUIDE Participants in the established program track should be prepared to begin furnishing services under the GUIDE Design on July 1, 2024, and bill for those services during the Design Efficiency Duration.

Yes, GUIDE beneficiary and supplier overlap with the Shared Cost savings Program is permitted. 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 support for individuals with dementia and their caretakers will assist enhance population-based care outcomes overall.

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The Dementia Care Management Payment (DCMP), the per beneficiary monthly GUIDE payment, will be consisted of in 2024 Shared Cost savings Program expenses. When 2024 becomes a benchmark year, DCMPs will be included in Shared Cost savings Program benchmark computations. As an example, if an ACO is taking part in both the GUIDE Design and the Shared Cost Savings Program throughout Efficiency Year 2024 and after that restores and starts a new contract period as of January 1, 2025, that ACO would have their Shared 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 expenditures, shared savings, nor benchmarking beginning in 2024 for the period of the GUIDE Design.

GUIDE Individuals may participate in multiple CMS Innovation Center designs or Medicare value-based care efforts to speed up development in care shipment, decrease the cost of care, and enhance population health. Individuals and recipients are qualified to participate 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 claims in the REACH ACOs' overall cost of care expenses or estimation of shared savings/shared losses.

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

As of January 1, 2025, GUIDE Individuals also getting involved in ACO REACH should discontinue billing the Medicare Physician Fee Set up Providers included under the DCMP (See Exhibit 5 in the GUIDE Payment Approach Paper (PDF)). Participants getting involved in both models must follow the GUIDE billing requirements in the GUIDE Participation Arrangement and GUIDE Payment Method Paper.

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The GUIDE Individual should not bill Medicare individually for the services provided in the thorough assessment. The detailed evaluation (and any re-assessments) is covered by the DCMP. If CMS identifies the recipient is not qualified for the GUIDE Model, the GUIDE Participant can bill for a proper Medicare-covered professional service that corresponds to the services rendered.