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GUIDE Individuals have the alternative, and are not required, to make offered respite through an adult day center or a 24-hour center. Extra GUIDE Respite Services requirements and information surrounding the payment for such services are specified in the Involvement Agreement.

The facilities payment is meant for providers who desire to develop brand-new dementia care programs and need resources to start. GUIDE Individuals qualified as a safeguard provider based upon the percentage of their client population that is dually qualified for Medicare and Medicaid or get the Part D low-income aid.

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To certify as a GUIDE security web company, a new program applicant should have had a Medicare FFS beneficiary population made up of at least 36% recipients receiving 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 break services will be subject to recipient cost-sharing.

When a lined up beneficiary is re-assessed and designated to a brand-new tier, the GUIDE Individual will be eligible to bill the G-code for the established client payment rate connected with that tier the following month. GUIDE Individuals that withdraw or are terminated before the start of the second performance year will be required to pay back the whole value of their infrastructure payment to CMS.

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After the second efficiency year, GUIDE Participants that withdraw or are ended from the GUIDE Model are not required to pay back the infrastructure payment. The main 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 change fee-for-service payment for some existing Medicare Doctor Cost Schedule (PFS) services, including chronic 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 Individuals will continue to bill under conventional Medicare fee-for-service for all services that are not included under the DCMP. CMS might include or remove codes over time to reflect modifications in PFS billing codes.

The care team might consist of the recipient's primary care provider, and if not, the care team is required to determine and share information with the recipient's medical care company and specialists and detail the care coordination services required to handle the beneficiary's dementia and co-occurring conditions. CMS will provide GUIDE Participants information associated with the performance determines that CMS utilizes to figure out the GUIDE Individual's performance-based modification to the DCMP.GUIDE Individuals in the established program track should be prepared to begin providing services under the GUIDE Design on July 1, 2024, and costs for those services throughout the Model Efficiency Period.

Yes, GUIDE recipient and service provider overlap with the Shared Savings Program is enabled. The GUIDE Model is developed to be suitable with other CMS models and programs that intend to enhance care and minimize spending. CMS thinks targeted support for individuals with dementia and their caregivers will assist enhance population-based care results overall.

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The Dementia Care Management Payment (DCMP), the per recipient each month 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 Savings Program benchmark computations. As an example, if an ACO is participating in both the GUIDE Design and the Shared Savings Program throughout Efficiency Year 2024 and then renews and begins a new contract duration as of January 1, 2025, that ACO would have their Shared Savings Program criteria based upon 2022, 2023 and 2024, and would have DCMPs counted in Criteria Year 3. GUIDE Break Service claims will not be counted towards ACO expenses, shared cost savings, nor benchmarking start in 2024 for the period of the GUIDE Design.

GUIDE Individuals may take part in multiple CMS Innovation Center models or Medicare value-based care initiatives to speed up development in care delivery, minimize the cost of care, and improve population health. Participants and recipients are eligible 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 Reprieve Service claims in the REACH ACOs' total cost of care expenses or calculation of shared savings/shared losses.

Overlapping individuals should follow GUIDE billing assistance as set forth below. ACO REACH claim reductions will not apply to DCMP. ACO REACH will include DCMP expenditures for functions of positioning computations. Nevertheless, GUIDE Break Service claims will not count towards ACO expenses, shared cost savings, or benchmarking in 2025 and throughout of the GUIDE Design.

As of January 1, 2025, GUIDE Participants likewise participating in ACO REACH ought to cease billing the Medicare Physician Cost Set up Solutions included under the DCMP (See Display 5 in the GUIDE Payment Methodology Paper (PDF)). Individuals participating in both designs should follow the GUIDE billing requirements in the GUIDE Involvement Contract and GUIDE Payment Method Paper.

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The GUIDE Individual must not bill Medicare separately for the services provided in the extensive evaluation. The comprehensive assessment (and any re-assessments) is covered by the DCMP. If CMS figures out the recipient is not eligible for the GUIDE Model, the GUIDE Participant can bill for a proper Medicare-covered professional service that corresponds to the services rendered.