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Nevertheless, GUIDE Participants have the option, and are not required, to make readily available respite through an adult day center or a 24-hour center. Additional GUIDE Break Services requirements and details surrounding the payment for such services are defined in the Participation Arrangement. GUIDE Individuals in the new program track that are categorized as safeguard providers will be eligible to get a one-time infrastructure payment of $75,000 (geographically changed by the Geographic Change Factor [GAF] to cover some of the upfront costs of developing a brand-new dementia care program.

The facilities payment is intended for service providers who wish to develop new dementia care programs and require resources to begin. GUIDE Participants certified as a safeguard service provider based on the percentage of their patient 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 need to have had a Medicare FFS beneficiary population made up of at least 36% beneficiaries getting 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 respite services will be subject to 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 patient payment rate related to that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the second efficiency year will be required to repay the entire value of their infrastructure payment to CMS.

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After the 2nd efficiency year, GUIDE Participants that withdraw or are terminated from the GUIDE Model are not required to pay back 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 Physician Fee Schedule (PFS) services, including persistent care management and principal care management, transitional care management, advance care planning, 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 traditional 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 offered in the Request for Applications (Table 8, pg. 35). CMS might add or remove codes gradually to reflect changes in PFS billing codes.

The care group might consist of the recipient's primary care company, and if not, the care group is needed to recognize and share info with the beneficiary's medical care provider and experts and describe the care coordination services required to manage the beneficiary's dementia and co-occurring conditions. CMS will provide GUIDE Participants data connected to the performance measures that CMS uses to identify the GUIDE Individual's performance-based change to the DCMP.GUIDE Individuals in the established program track should be prepared to start furnishing services under the GUIDE Design on July 1, 2024, and costs for those services during the Design Efficiency Duration.

Yes, GUIDE recipient and supplier overlap with the Shared Cost savings Program is enabled. The GUIDE Model is created to be compatible with other CMS designs and programs that intend to enhance care and minimize spending. CMS thinks targeted assistance for people with dementia and their caregivers will assist improve population-based care results overall.

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The Dementia Care Management Payment (DCMP), the per beneficiary monthly GUIDE payment, will be consisted of in 2024 Shared Cost savings Program expenditures. When 2024 ends up being a benchmark year, DCMPs will be included in Shared Savings Program standard calculations. As an example, if an ACO is taking part in both the GUIDE Design and the Shared Savings Program throughout Efficiency Year 2024 and after that renews and starts a brand-new arrangement duration since January 1, 2025, that ACO would have their Shared Cost savings Program criteria based upon 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 Model.

GUIDE Participants may take part in several 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. Individuals and beneficiaries are qualified to take part in the GUIDE Model and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not include the Dementia Care Management Payment (DCMP) or Reprieve Service declares in the REACH ACOs' overall expense of care expenses or calculation of shared savings/shared losses.

Overlapping individuals need to follow GUIDE billing guidance as set forth listed below. ACO REACH claim reductions will not use to DCMP. ACO REACH will include DCMP expenditures for functions of alignment calculations. GUIDE Break Service claims will not count towards ACO expenses, shared savings, or benchmarking in 2025 and for the period of the GUIDE Design.

Since January 1, 2025, GUIDE Participants also taking part in ACO REACH ought to terminate billing the Medicare Doctor Cost Arrange Services included under the DCMP (See Display 5 in the GUIDE Payment Approach Paper (PDF)). Individuals taking part in both models need to follow the GUIDE billing requirements in the GUIDE Involvement Arrangement and GUIDE Payment Method Paper.

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The GUIDE Individual need to not bill Medicare separately for the services offered in the thorough evaluation. The thorough assessment (and any re-assessments) is covered by the DCMP. If CMS figures out the beneficiary is not eligible for the GUIDE Model, the GUIDE Individual can bill for a suitable Medicare-covered professional service that represents the services rendered.