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GUIDE Participants have the option, and are not needed, to make offered reprieve through an adult day center or a 24-hour center. Extra GUIDE Reprieve Providers requirements and information surrounding the payment for such services are defined in the Involvement Contract.

The infrastructure payment is planned for companies who wish to develop new dementia care programs and need resources to begin. GUIDE Individuals qualified as a safety net company based upon the proportion of their patient population that is dually eligible for Medicare and Medicaid or receive the Part D low-income aid.

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To certify as a GUIDE security net company, a brand-new program applicant should have had a Medicare FFS recipient population made up of a minimum of 36% beneficiaries receiving the Part D low-income subsidy or 33.7% beneficiaries who are dually eligible 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 an aligned beneficiary is re-assessed and appointed to a brand-new tier, the GUIDE Individual will be eligible to bill the G-code for the established patient payment rate connected with that tier the following month. GUIDE Individuals that withdraw or are ended before the start of the second performance year will be required to repay the entire value of their facilities payment to CMS.

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After the 2nd efficiency year, GUIDE Participants that withdraw or are ended from the GUIDE Model are not needed to pay back the infrastructure payment. The main design payment under the GUIDE Model 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 Doctor Fee Set Up (PFS) services, consisting of 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 model, 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 include or get rid of codes over time to reflect changes in PFS billing codes.

The care group may consist of the beneficiary's medical care service provider, and if not, the care team is required to recognize and share details with the recipient's medical care service provider and specialists and outline the care coordination services needed to handle the beneficiary's dementia and co-occurring conditions. CMS will offer GUIDE Individuals data related to the performance measures that CMS uses to determine the GUIDE Individual's performance-based adjustment to the DCMP.GUIDE Individuals in the recognized program track need to be prepared to begin providing services under the GUIDE Design on July 1, 2024, and costs for those services throughout the Design Performance Period.

Yes, GUIDE beneficiary and supplier overlap with the Shared Cost savings Program is permitted. The GUIDE Design is developed to be suitable with other CMS designs and programs that aim to enhance care and decrease spending. CMS thinks targeted assistance for people with dementia and their caretakers will assist enhance population-based care outcomes in general.

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As an example, if an ACO is getting involved in both the GUIDE Model and the Shared Cost Savings Program throughout Performance Year 2024 and then renews and starts a new agreement 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 Standard Year 3. GUIDE Break Service claims will not be counted toward ACO expenditures, shared cost savings, nor benchmarking beginning in 2024 for the period of the GUIDE Design.

GUIDE Participants might take part in several CMS Innovation Center designs or Medicare value-based care initiatives to speed up development in care shipment, reduce the cost of care, and enhance population health. Participants and beneficiaries are qualified to take part 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 Reprieve Service claims in the REACH ACOs' overall expense of care expenses or calculation of shared savings/shared losses.

Overlapping individuals need to follow GUIDE billing assistance as stated below. ACO REACH claim reductions will not use to DCMP. ACO REACH will consist of DCMP expenditures for functions of positioning estimations. GUIDE Respite Service claims will not count toward ACO expenses, shared cost savings, or benchmarking in 2025 and for the duration of the GUIDE Model.

Since January 1, 2025, GUIDE Participants also taking part in ACO REACH need to stop billing the Medicare Physician Charge Arrange Services consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Method 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 provided in the comprehensive evaluation. The detailed assessment (and any re-assessments) is covered by the DCMP. If CMS determines the recipient is not qualified for the GUIDE Model, the GUIDE Participant can bill for a proper Medicare-covered professional service that corresponds to the services rendered.