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GUIDE Individuals have the choice, and are not required, to make available reprieve through an adult day center or a 24-hour center. Additional GUIDE Respite Services requirements and details surrounding the payment for such services are specified in the Involvement Agreement.

The facilities payment is meant for providers who desire to develop new dementia care programs and require resources to start. GUIDE Participants qualified as a safeguard provider based on the percentage of their patient population that is dually qualified for Medicare and Medicaid or receive the Part D low-income subsidy.

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To qualify as a GUIDE safeguard supplier, a brand-new program candidate must have had a Medicare FFS beneficiary population comprised of a minimum of 36% recipients 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 undergo beneficiary cost-sharing.

When an aligned beneficiary is re-assessed and appointed to a brand-new tier, the GUIDE Participant will be qualified to bill the G-code for the established 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 required to repay the whole worth of their facilities 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 needed to pay back the facilities payment. The main 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 replace fee-for-service payment for some existing Medicare Physician Charge Arrange (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 Design is not a total-cost-of-care model, so GUIDE Participants will continue to costs under conventional Medicare fee-for-service for all services that are not included under the DCMP. CMS might include or eliminate codes over time to reflect changes in PFS billing codes.

The care group might consist of the beneficiary's medical care company, and if not, the care team is required to determine and share info with the beneficiary's primary care company and experts and describe the care coordination services required to manage the beneficiary's dementia and co-occurring conditions. CMS will provide GUIDE Participants information associated with the efficiency determines that CMS uses to figure out the GUIDE Individual's performance-based adjustment to the DCMP.GUIDE Individuals in the recognized program track should be prepared to start furnishing services under the GUIDE Model on July 1, 2024, and expense for those services during the Model Performance Period.

Yes, GUIDE beneficiary and provider overlap with the Shared Cost savings Program is allowed. The GUIDE Design is designed to be suitable with other CMS models and programs that aim to enhance care and decrease spending. CMS believes targeted assistance for people with dementia and their caregivers will help enhance population-based care outcomes 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 Efficiency Year 2024 and then restores and starts a new agreement period 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 expenditures, shared cost savings, nor benchmarking start in 2024 for the period of the GUIDE Model.

GUIDE Individuals may take part in numerous CMS Development Center models or Medicare value-based care efforts to speed up innovation in care shipment, reduce the cost of care, and enhance population health. Participants and recipients are eligible to participate 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 Break Service declares in the REACH ACOs' total cost of care expenses or estimation of shared savings/shared losses.

Overlapping participants should follow GUIDE billing assistance as set forth below. GUIDE Respite Service claims will not count toward ACO expenditures, shared savings, or benchmarking in 2025 and for the duration of the GUIDE Design.

As of January 1, 2025, GUIDE Individuals likewise taking part in ACO REACH should stop billing the Medicare Physician Cost Schedule Solutions included under the DCMP (See Exhibition 5 in the GUIDE Payment Methodology Paper (PDF)). Participants taking part in both designs must follow the GUIDE billing requirements in the GUIDE Involvement Agreement and GUIDE Payment Methodology Paper.

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The GUIDE Individual should not bill Medicare independently for the services provided in the extensive evaluation. The thorough evaluation (and any re-assessments) is covered by the DCMP. If CMS determines the beneficiary is not eligible for the GUIDE Design, the GUIDE Participant can bill for a suitable Medicare-covered professional service that represents the services rendered.