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

The facilities payment is planned for service providers who wish to establish new dementia care programs and require resources to get started. 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 subsidy.

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To certify as a GUIDE security web provider, a brand-new program candidate should have had a Medicare FFS beneficiary population consisted of a minimum of 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 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 associated with that tier the following month. GUIDE Participants that withdraw or are ended before the start of the second efficiency year will be required to repay the whole value of their infrastructure payment to CMS.

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After the second efficiency year, GUIDE Participants that withdraw or are terminated from the GUIDE Model are not required to repay the facilities payment. The main design 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 Fee Schedule (PFS) services, consisting of persistent care management and primary 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 Individuals will continue to bill under traditional Medicare fee-for-service for all services that are not included under the DCMP. CMS may add or remove codes over time to reflect modifications in PFS billing codes.

The care group may include the beneficiary's medical care company, and if not, the care group is required to recognize and share information with the beneficiary's main care supplier and professionals and detail the care coordination services required to manage the beneficiary's dementia and co-occurring conditions. CMS will provide GUIDE Individuals information related to the performance measures that CMS uses to identify the GUIDE Individual's performance-based adjustment to the DCMP.GUIDE Participants in the established program track must be prepared to start providing services under the GUIDE Model on July 1, 2024, and costs for those services during the Design Performance Duration.

Yes, GUIDE recipient and provider overlap with the Shared Savings Program is enabled. The GUIDE Design is designed to be compatible with other CMS designs and programs that intend to enhance care and lower costs. CMS thinks targeted support for individuals with dementia and their caretakers will help enhance population-based care results in general.

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The Dementia Care Management Payment (DCMP), the per beneficiary monthly GUIDE payment, will be included in 2024 Shared Savings Program expenses. When 2024 ends up being a benchmark year, DCMPs will be included in Shared Cost savings Program benchmark calculations. As an example, if an ACO is taking part in both the GUIDE Model and the Shared Cost Savings Program during Efficiency Year 2024 and after that renews and starts a brand-new arrangement period since January 1, 2025, that ACO would have their Shared Cost savings Program benchmark based upon 2022, 2023 and 2024, and would have DCMPs counted in Standard Year 3. GUIDE Break Service claims will not be counted toward ACO expenditures, shared cost savings, nor benchmarking start in 2024 for the period of the GUIDE Design.

GUIDE Participants may take part in numerous CMS Innovation Center models or Medicare value-based care efforts to speed up innovation in care shipment, lower the expense of care, and enhance population health. Participants and recipients are qualified to take part in the GUIDE Model 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 declares in the REACH ACOs' overall cost of care expenses or estimation of shared savings/shared losses.

Overlapping individuals ought to follow GUIDE billing guidance as set forth listed below. ACO REACH claim decreases will not use to DCMP. ACO REACH will include DCMP expenses for purposes of alignment calculations. However, GUIDE Respite 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 Individuals likewise taking part in ACO REACH need to terminate billing the Medicare Doctor Charge Schedule Services consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Methodology Paper (PDF)). Participants taking part in both models must follow the GUIDE billing requirements in the GUIDE Participation Contract and GUIDE Payment Method Paper.

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The GUIDE Participant need to not bill Medicare individually for the services provided in the comprehensive assessment. The detailed assessment (and any re-assessments) is covered by the DCMP. If CMS figures out the recipient is not eligible for the GUIDE Design, the GUIDE Participant can bill for an appropriate Medicare-covered expert service that corresponds to the services rendered.