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GUIDE Participants have the alternative, and are not required, to make offered break through an adult day center or a 24-hour facility. Additional GUIDE Break Solutions requirements and information surrounding the payment for such services are defined in the Involvement Agreement. GUIDE Individuals in the new program track that are classified as security net suppliers will be eligible to get a one-time facilities payment of $75,000 (geographically adjusted by the Geographic Adjustment Aspect [GAF] to cover some of the in advance costs of developing a new dementia care program.

The infrastructure payment is intended for companies who desire to develop new dementia care programs and need resources to begin. GUIDE Participants qualified as a safeguard supplier 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 safeguard supplier, a brand-new program candidate should have had a Medicare FFS recipient population made up of a minimum of 36% recipients receiving 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 a lined up recipient is re-assessed and designated to a new tier, the GUIDE Individual will be eligible to bill the G-code for the recognized client payment rate connected with that tier the following month. GUIDE Individuals that withdraw or are ended before the start of the 2nd performance year will be needed to repay the entire worth of their infrastructure payment to CMS.

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After the 2nd efficiency year, GUIDE Individuals that withdraw or are ended from the GUIDE Design are not required to pay back the facilities payment. The primary 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 Charge Schedule (PFS) services, consisting of persistent care management and principal care management, transitional care management, advance care preparation, and technology-based check-ins.

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The GUIDE Design is not a total-cost-of-care model, so GUIDE Participants will continue to bill under conventional Medicare fee-for-service for all services that are not included under the DCMP. CMS may add or eliminate codes over time to show changes in PFS billing codes.

The care group may consist of the recipient's medical care company, and if not, the care group is needed to identify and share information with the beneficiary's medical care service provider and experts and detail the care coordination services required to manage the beneficiary's dementia and co-occurring conditions. CMS will offer GUIDE Individuals data associated with the performance determines that CMS uses to identify the GUIDE Individual's performance-based modification to the DCMP.GUIDE Participants in the recognized program track need to be prepared to begin furnishing services under the GUIDE Design on July 1, 2024, and costs for those services during the Design Efficiency Period.

Yes, GUIDE beneficiary and company overlap with the Shared Cost savings Program is allowed. The GUIDE Design is created to be suitable with other CMS designs and programs that aim to enhance care and reduce spending. CMS believes targeted assistance for individuals with dementia and their caretakers will assist enhance population-based care outcomes in general.

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The Dementia Care Management Payment (DCMP), the per recipient per month GUIDE payment, will be included in 2024 Shared Cost savings Program expenses. 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 Model and the Shared Savings Program throughout Efficiency Year 2024 and after that renews and starts a brand-new arrangement 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 Break Service claims will not be counted toward ACO expenditures, shared cost savings, nor benchmarking beginning in 2024 for the period of the GUIDE Model.

GUIDE Participants may get involved in numerous CMS Innovation Center designs or Medicare value-based care efforts to accelerate development in care shipment, reduce the expense of care, and enhance population health. Individuals and recipients are qualified to get involved in the GUIDE Design and the ACO REACH Model. For the rest of CY 2024, ACO REACH will not include the Dementia Care Management Payment (DCMP) or Respite Service claims in the REACH ACOs' total expense of care expenses or estimation of shared savings/shared losses.

Overlapping individuals need to follow GUIDE billing guidance as stated below. ACO REACH claim reductions will not apply to DCMP. ACO REACH will include DCMP expenditures for functions of positioning calculations. GUIDE Reprieve Service claims will not count towards ACO expenditures, shared cost savings, or benchmarking in 2025 and for the duration of the GUIDE Model.

Since January 1, 2025, GUIDE Individuals also taking part in ACO REACH ought to terminate billing the Medicare Doctor Cost Set up Providers consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Methodology Paper (PDF)). Participants getting involved in both designs must follow the GUIDE billing requirements in the GUIDE Involvement Arrangement and GUIDE Payment Method Paper.

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