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

The infrastructure payment is meant for providers who want to develop brand-new dementia care programs and need resources to get begun. GUIDE Individuals certified as a safeguard supplier based on the proportion of their patient population that is dually qualified for Medicare and Medicaid or receive the Part D low-income subsidy.

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To certify as a GUIDE safety web supplier, a new program applicant must have had a Medicare FFS recipient population made up of a minimum of 36% beneficiaries receiving the Part D low-income subsidy 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 respite services will go through beneficiary cost-sharing.

When a lined up beneficiary is re-assessed and assigned to a new tier, the GUIDE Participant will be eligible to bill the G-code for the recognized patient payment rate related to that tier the following month. GUIDE Individuals that withdraw or are ended before the start of the 2nd efficiency year will be required to pay back the entire worth of their facilities payment to CMS.

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After the 2nd efficiency year, GUIDE Participants that withdraw or are ended from the GUIDE Design are not needed to repay the infrastructure 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 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 Design is not a total-cost-of-care model, so GUIDE Participants will continue to bill under standard Medicare fee-for-service for all services that are not consisted of under the DCMP. Extra details, including a complete list of duplicative codes, is available in the Ask for Applications (Table 8, pg. 35). CMS may add or eliminate codes with time to reflect changes in PFS billing codes.

The care group might consist of the recipient's medical care supplier, and if not, the care group is required to determine and share info with the recipient's main care company and experts and describe the care coordination services needed to manage the recipient's dementia and co-occurring conditions. CMS will supply GUIDE Individuals information related to the performance determines that CMS utilizes to figure out the GUIDE Participant's performance-based modification to the DCMP.GUIDE Participants in the established program track must be prepared to start furnishing services under the GUIDE Model on July 1, 2024, and bill for those services during the Design Performance 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 intend to enhance care and lower spending. CMS believes targeted support for individuals with dementia and their caretakers will assist improve 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 Savings Program expenses. When 2024 becomes a benchmark year, DCMPs will be included in Shared Cost savings Program standard estimations. As an example, if an ACO is getting involved in both the GUIDE Model and the Shared Savings Program throughout Performance Year 2024 and then restores and starts a brand-new contract period since January 1, 2025, that ACO would have their Shared Cost savings Program standard based upon 2022, 2023 and 2024, and would have DCMPs counted in Benchmark Year 3. GUIDE Reprieve Service claims will not be counted toward ACO expenses, shared savings, nor benchmarking beginning in 2024 for the duration of the GUIDE Model.

GUIDE Participants may take part in several CMS Development Center designs or Medicare value-based care efforts to accelerate development in care delivery, lower the cost of care, and enhance population health. Individuals and recipients are qualified to take part in the GUIDE Model and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not consist of the Dementia Care Management Payment (DCMP) or Reprieve Service declares in the REACH ACOs' total cost of care expenses or estimation of shared savings/shared losses.

Overlapping individuals must follow GUIDE billing assistance as set forth listed 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.

As of January 1, 2025, GUIDE Participants likewise participating in ACO REACH must discontinue billing the Medicare Doctor Cost Arrange Solutions included under the DCMP (See Display 5 in the GUIDE Payment Approach Paper (PDF)). Participants participating 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 should not bill Medicare individually for the services provided in the detailed evaluation. The comprehensive assessment (and any re-assessments) is covered by the DCMP. If CMS determines the beneficiary is not eligible for the GUIDE Design, the GUIDE Individual can bill for a proper Medicare-covered professional service that represents the services rendered.