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GUIDE Individuals have the choice, and are not required, to make readily available reprieve through an adult day center or a 24-hour facility. Additional GUIDE Break Solutions requirements and details surrounding the payment for such services are defined in the Participation Agreement.

The infrastructure payment is intended for suppliers who want to develop new dementia care programs and require resources to begin. GUIDE Participants qualified as a safety net provider based upon the proportion 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 qualify as a GUIDE safeguard service provider, a new program candidate must have had a Medicare FFS recipient population consisted of at least 36% recipients 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 reprieve 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 qualified to bill the G-code for the recognized patient payment rate associated with that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the 2nd efficiency year will be required to pay back the entire value 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 needed 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 preparation, and technology-based check-ins.

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The GUIDE Model is not a total-cost-of-care model, so GUIDE Participants will continue to expense under standard Medicare fee-for-service for all services that are not consisted of under the DCMP. Extra info, including a total list of duplicative codes, is readily available in the Ask for Applications (Table 8, pg. 35). CMS might add or remove codes with time to reflect changes in PFS billing codes.

The care group might consist of the recipient's primary care supplier, and if not, the care team is required to recognize and share details with the recipient's medical care service provider and specialists and describe the care coordination services required to manage the recipient's dementia and co-occurring conditions. CMS will offer GUIDE Participants data associated with the performance measures that CMS uses to figure out the GUIDE Participant's performance-based adjustment to the DCMP.GUIDE Participants in the established program track should be prepared to start furnishing services under the GUIDE Design on July 1, 2024, and bill for those services during the Design Performance Duration.

Yes, GUIDE beneficiary and company overlap with the Shared Savings Program is enabled. The GUIDE Model is designed to be compatible with other CMS models and programs that intend to enhance care and lower costs. CMS believes targeted support for people with dementia and their caregivers will help improve population-based care results in general.

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The Dementia Care Management Payment (DCMP), the per beneficiary each month GUIDE payment, will be included in 2024 Shared Cost savings Program expenditures. When 2024 ends up being a benchmark year, DCMPs will be consisted of in Shared Cost savings Program criteria computations. As an example, if an ACO is taking part in both the GUIDE Model and the Shared Cost Savings Program throughout Performance Year 2024 and after that restores and starts a brand-new agreement 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 Standard 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 Participants may get involved in multiple CMS Development Center models or Medicare value-based care initiatives to speed up innovation in care delivery, minimize the cost of care, and improve population health. Individuals and beneficiaries are eligible to participate in the GUIDE Design and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not consist of the Dementia Care Management Payment (DCMP) or Respite Service claims in the REACH ACOs' total expense of care expenditures or calculation of shared savings/shared losses.

Overlapping individuals must follow GUIDE billing guidance as set forth listed below. GUIDE Break Service claims will not count toward ACO expenditures, shared 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 Physician Charge Arrange Services included under the DCMP (See Exhibit 5 in the GUIDE Payment Method Paper (PDF)). Individuals taking part in both models should follow the GUIDE billing requirements in the GUIDE Involvement Contract and GUIDE Payment Method Paper.

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The GUIDE Participant must not bill Medicare independently for the services provided in the comprehensive evaluation. The detailed assessment (and any re-assessments) is covered by the DCMP. If CMS identifies the recipient is not eligible for the GUIDE Design, the GUIDE Participant can bill for a suitable Medicare-covered professional service that corresponds to the services rendered.