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

The infrastructure payment is meant for suppliers who wish to develop new dementia care programs and need resources to get going. GUIDE Individuals certified as a safeguard service provider based upon the proportion of their patient 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 safeguard supplier, a new program candidate need to have had a Medicare FFS beneficiary population consisted of at least 36% recipients getting the Part D low-income subsidy or 33.7% beneficiaries 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 be subject to recipient cost-sharing.

When a lined up beneficiary is re-assessed and designated to a brand-new tier, the GUIDE Participant will be eligible to bill the G-code for the recognized client payment rate connected with that tier the following month. GUIDE Participants that withdraw or are ended before the start of the 2nd efficiency year will be required to pay back the whole value of their facilities payment to CMS.

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After the second performance year, GUIDE Individuals that withdraw or are ended from the GUIDE Model are not needed to pay back the facilities 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 change fee-for-service payment for some existing Medicare Physician Cost Schedule (PFS) services, consisting of 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 Participants will continue to costs under traditional Medicare fee-for-service for all services that are not included under the DCMP. Additional info, including a complete list of duplicative codes, is available in the Request for Applications (Table 8, pg. 35). CMS may include or eliminate codes gradually to reflect changes in PFS billing codes.

The care team might include the beneficiary's medical care service provider, and if not, the care group is required to determine and share details with the beneficiary's medical care service provider and specialists and detail the care coordination services needed to manage the beneficiary's dementia and co-occurring conditions. CMS will supply GUIDE Individuals data connected to the efficiency measures that CMS utilizes to determine the GUIDE Participant's performance-based change to the DCMP.GUIDE Individuals in the recognized program track must be prepared to begin providing services under the GUIDE Design on July 1, 2024, and costs for those services throughout the Model Efficiency Duration.

Yes, GUIDE beneficiary and supplier overlap with the Shared Savings Program is enabled. The GUIDE Design is developed to be suitable with other CMS designs and programs that aim to improve care and lower costs. CMS thinks targeted support for individuals with dementia and their caretakers will help enhance population-based care outcomes in general.

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As an example, if an ACO is taking part in both the GUIDE Design and the Shared Savings Program during Performance Year 2024 and then renews and starts a new arrangement duration as of January 1, 2025, that ACO would have their Shared Savings Program criteria based on 2022, 2023 and 2024, and would have DCMPs counted in Criteria Year 3. GUIDE Respite Service claims will not be counted towards ACO expenses, shared savings, nor benchmarking start in 2024 for the duration of the GUIDE Model.

GUIDE Participants may take part in several CMS Innovation Center designs or Medicare value-based care initiatives to speed up innovation in care shipment, lower the expense of care, and improve population health. Individuals and beneficiaries are qualified to participate in the GUIDE Design and the ACO REACH Design. 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 computation of shared savings/shared losses.

Overlapping individuals need to follow GUIDE billing guidance as set forth below. ACO REACH claim decreases will not use to DCMP. ACO REACH will include DCMP expenditures for functions of positioning computations. Nevertheless, GUIDE Reprieve Service claims will not count towards ACO expenditures, shared cost 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 need to terminate billing the Medicare Doctor Charge Schedule Services consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Method Paper (PDF)). Participants getting involved in both models need to follow the GUIDE billing requirements in the GUIDE Participation Arrangement and GUIDE Payment Methodology Paper.

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The GUIDE Individual need to not bill Medicare separately for the services offered in the comprehensive assessment. The extensive assessment (and any re-assessments) is covered by the DCMP. If CMS determines the beneficiary is not qualified for the GUIDE Model, the GUIDE Participant can bill for a proper Medicare-covered expert service that represents the services rendered.