Key Development Stacks to Adopt in 2026

GUIDE Individuals have the alternative, and are not needed, to make offered reprieve through an adult day center or a 24-hour facility. Additional GUIDE Break Providers requirements and information surrounding the payment for such services are defined in the Involvement Contract.

The facilities payment is planned for suppliers who wish to establish new dementia care programs and need resources to start. GUIDE Participants qualified as a safety net company based on the proportion of their patient population that is dually qualified for Medicare and Medicaid or receive the Part D low-income aid.

NEWMEDIA

To certify as a GUIDE safeguard supplier, a new program applicant must have had a Medicare FFS recipient population consisted of at least 36% recipients getting 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 undergo beneficiary cost-sharing.

When a lined up recipient is re-assessed and appointed to a brand-new tier, the GUIDE Participant will be qualified to bill the G-code for the recognized client payment rate connected with that tier the following month. GUIDE Individuals that withdraw or are ended before the start of the 2nd performance year will be needed to repay the whole value of their facilities payment to CMS.

NEWMEDIA

After the 2nd performance year, GUIDE Individuals that withdraw or are terminated from the GUIDE Model are not required to repay the infrastructure payment. The primary 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 change fee-for-service payment for some existing Medicare Doctor Cost Set Up (PFS) services, including chronic care management and primary care management, transitional care management, advance care planning, and technology-based check-ins.

Mastering Modern Digital Strategy to Maximum Growth

The GUIDE Model is not a total-cost-of-care design, so GUIDE Participants will continue to expense under traditional Medicare fee-for-service for all services that are not consisted of under the DCMP. CMS may add or eliminate codes over time to reflect modifications in PFS billing codes.

The care team may consist of the beneficiary's primary care supplier, and if not, the care team is required to identify and share info with the beneficiary's main care company and specialists and lay out the care coordination services required to manage the beneficiary's dementia and co-occurring conditions. CMS will offer GUIDE Participants data connected to the efficiency measures that CMS utilizes to determine the GUIDE Individual's performance-based change 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 throughout the Model Performance Duration.

Yes, GUIDE beneficiary and company overlap with the Shared Savings Program is allowed. The GUIDE Model is created to be compatible with other CMS models and programs that intend to enhance care and reduce costs. CMS believes targeted support for people with dementia and their caretakers will assist enhance population-based care outcomes in general.

Key Development Stacks to Consider in 2026

As an example, if an ACO is getting involved in both the GUIDE Design and the Shared Cost Savings Program throughout Efficiency Year 2024 and then restores and begins a brand-new arrangement period as of January 1, 2025, that ACO would have their Shared Cost savings Program benchmark based on 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 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 efforts to speed up innovation in care shipment, minimize the cost of care, and improve population health. Participants and beneficiaries are qualified 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 claims in the REACH ACOs' total cost of care expenses or computation of shared savings/shared losses.

Overlapping participants need to follow GUIDE billing guidance as set forth listed below. ACO REACH claim reductions will not apply to DCMP. ACO REACH will include DCMP expenditures for purposes of alignment calculations. GUIDE Respite Service claims will not count toward ACO expenses, shared cost savings, or benchmarking in 2025 and for the duration of the GUIDE Design.

Since January 1, 2025, GUIDE Individuals likewise getting involved in ACO REACH must terminate billing the Medicare Doctor Fee Arrange Solutions included under the DCMP (See Exhibition 5 in the GUIDE Payment Approach Paper (PDF)). Individuals getting involved in both designs should follow the GUIDE billing requirements in the GUIDE Involvement Contract and GUIDE Payment Method Paper.

Future-Proofing Digital App Architectures for 2026

The GUIDE Participant must not bill Medicare independently for the services offered in the extensive assessment. The thorough 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 a suitable Medicare-covered expert service that corresponds to the services rendered.