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GUIDE Individuals have the choice, and are not required, to make offered reprieve through an adult day center or a 24-hour facility. Extra GUIDE Reprieve Providers requirements and details surrounding the payment for such services are specified in the Participation Agreement.

The facilities payment is planned for suppliers who want to establish new dementia care programs and need resources to begin. GUIDE Participants certified as a safeguard supplier based on the percentage of their client 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 safeguard provider, a new program candidate need to have had a Medicare FFS recipient population comprised of at least 36% beneficiaries 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 reprieve services will undergo recipient cost-sharing.

When an aligned beneficiary is re-assessed and assigned to a brand-new tier, the GUIDE Individual will be qualified to bill the G-code for the established client payment rate related to that tier the following month. GUIDE Individuals that withdraw or are terminated before the start of the 2nd efficiency year will be needed to repay the entire worth of their infrastructure payment to CMS.

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After the 2nd performance year, GUIDE Individuals that withdraw or are terminated from the GUIDE Design are not required to pay back the infrastructure 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 Physician Fee Set Up (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 design, so GUIDE Individuals will continue to expense under standard Medicare fee-for-service for all services that are not consisted of under the DCMP. CMS might include or remove codes over time to reflect changes in PFS billing codes.

The care team might include the beneficiary's medical care provider, and if not, the care team is required to identify and share info with the beneficiary's medical care supplier and specialists and outline the care coordination services needed to handle the beneficiary's dementia and co-occurring conditions. CMS will supply GUIDE Individuals information connected to the performance determines that CMS utilizes to figure out the GUIDE Participant's performance-based change to the DCMP.GUIDE Individuals in the established program track should be prepared to begin furnishing services under the GUIDE Design on July 1, 2024, and expense for those services throughout the Model Efficiency Duration.

Yes, GUIDE recipient and service provider overlap with the Shared Cost savings Program is permitted. The GUIDE Design is created to be suitable with other CMS models and programs that aim to improve care and lower costs. CMS believes targeted assistance for individuals with dementia and their caretakers will assist improve population-based care results overall.

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The Dementia Care Management Payment (DCMP), the per beneficiary each month GUIDE payment, will be included in 2024 Shared Savings Program expenditures. When 2024 ends up being a benchmark year, DCMPs will be included in Shared Cost savings Program benchmark estimations. As an example, if an ACO is getting involved in both the GUIDE Model and the Shared Savings Program during Efficiency Year 2024 and then renews and begins a new agreement duration since 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 Respite Service claims will not be counted towards ACO expenditures, shared savings, nor benchmarking beginning in 2024 for the period of the GUIDE Model.

GUIDE Individuals might participate in several CMS Development Center models or Medicare value-based care efforts to speed up development in care shipment, reduce the cost of care, and enhance population health. Individuals and recipients are eligible to get involved 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 Reprieve Service declares in the REACH ACOs' total cost of care expenses or computation of shared savings/shared losses.

Overlapping participants ought to follow GUIDE billing guidance as set forth below. GUIDE Reprieve Service claims will not count toward ACO expenditures, shared savings, or benchmarking in 2025 and for the period of the GUIDE Design.

As of January 1, 2025, GUIDE Participants likewise participating in ACO REACH should discontinue billing the Medicare Physician Fee 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 Participation Contract and GUIDE Payment Approach Paper.

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The GUIDE Individual should not bill Medicare independently for the services offered in the extensive assessment. The detailed evaluation (and any re-assessments) is covered by the DCMP. If CMS identifies the beneficiary is not qualified for the GUIDE Model, the GUIDE Individual can bill for an appropriate Medicare-covered expert service that corresponds to the services rendered.