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GUIDE Individuals have the alternative, and are not required, to make offered respite through an adult day center or a 24-hour center. Additional GUIDE Reprieve Solutions requirements and details surrounding the payment for such services are defined in the Involvement Agreement.

The facilities payment is planned for providers who wish to develop brand-new dementia care programs and need resources to get going. GUIDE Participants qualified as a safeguard supplier based on the percentage of their client population that is dually qualified for Medicare and Medicaid or receive the Part D low-income aid.

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To qualify as a GUIDE safeguard service provider, a new program candidate need to have had a Medicare FFS beneficiary population made up of a minimum of 36% beneficiaries getting the Part D low-income aid 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 respite services will go through beneficiary cost-sharing.

When an aligned recipient is re-assessed and designated to a new tier, the GUIDE Individual 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 terminated before the start of the second performance year will be needed to repay 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 required to repay the facilities payment. The primary model payment under the GUIDE Model 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 Fee Set Up (PFS) services, consisting of persistent care management and primary 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 design, so GUIDE Individuals will continue to expense under conventional Medicare fee-for-service for all services that are not included under the DCMP. CMS may add or get rid of codes over time to reflect changes in PFS billing codes.

The care group might include the beneficiary's medical care company, and if not, the care team is needed to recognize and share information with the beneficiary's medical care provider and professionals and describe 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 determines that CMS uses to identify the GUIDE Individual's performance-based change to the DCMP.GUIDE Individuals in the established program track must 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 provider overlap with the Shared Savings Program is enabled. The GUIDE Design is designed to be suitable with other CMS models and programs that intend to enhance care and decrease spending. CMS believes targeted support for people with dementia and their caregivers will help enhance population-based care results overall.

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As an example, if an ACO is participating in both the GUIDE Design and the Shared Cost Savings Program during Performance Year 2024 and then renews and starts a new contract period as of January 1, 2025, that ACO would have their Shared Savings Program benchmark based on 2022, 2023 and 2024, and would have DCMPs counted in Criteria Year 3. GUIDE Respite Service claims will not be counted toward ACO expenses, shared savings, nor benchmarking beginning in 2024 for the period of the GUIDE Design.

GUIDE Participants might get involved in multiple CMS Innovation Center models or Medicare value-based care efforts to accelerate innovation in care shipment, reduce the expense of care, and improve population health. Individuals and recipients are qualified to take part in the GUIDE Model and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not consist of the Dementia Care Management Payment (DCMP) or Break Service claims in the REACH ACOs' overall cost of care expenditures or computation of shared savings/shared losses.

Overlapping participants should follow GUIDE billing assistance as set forth below. ACO REACH claim reductions will not apply to DCMP. ACO REACH will consist of DCMP expenses for purposes of positioning calculations. GUIDE Break Service claims will not count towards ACO expenditures, shared savings, or benchmarking in 2025 and for the duration of the GUIDE Design.

Since January 1, 2025, GUIDE Participants likewise getting involved in ACO REACH need to stop billing the Medicare Doctor Charge Arrange Solutions consisted of under the DCMP (See Exhibition 5 in the GUIDE Payment Method Paper (PDF)). Individuals taking part in both models must follow the GUIDE billing requirements in the GUIDE Involvement Agreement and GUIDE Payment Method Paper.

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The GUIDE Participant should not bill Medicare individually for the services provided in the extensive assessment. The thorough assessment (and any re-assessments) is covered by the DCMP. If CMS figures out 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.