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GUIDE Participants have the alternative, and are not needed, to make available respite through an adult day center or a 24-hour facility. Extra GUIDE Break Solutions requirements and information surrounding the payment for such services are defined in the Involvement Agreement.

The facilities payment is meant for suppliers who wish to establish new dementia care programs and need resources to get started. GUIDE Individuals certified as a safeguard service provider based on the proportion 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 certify as a GUIDE safety internet supplier, a new program applicant need to have had a Medicare FFS beneficiary population consisted of a minimum of 36% recipients receiving the Part D low-income subsidy or 33.7% beneficiaries who are dually qualified for Medicare and Medicaid. Accepting the facilities payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE reprieve services will undergo recipient cost-sharing.

When an aligned recipient is re-assessed and assigned to a new tier, the GUIDE Participant will be qualified to bill the G-code for the established patient payment rate associated 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 pay back the entire value of their infrastructure payment to CMS.

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After the second performance year, GUIDE Individuals 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 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 Physician Fee Schedule (PFS) services, including chronic 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 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. Additional info, consisting of a complete list of duplicative codes, is available in the Ask for Applications (Table 8, pg. 35). CMS might add or get rid of codes with time to reflect modifications in PFS billing codes.

The care group might include the recipient's primary care provider, and if not, the care team is required to identify and share information with the beneficiary's medical care supplier and specialists and outline the care coordination services needed to manage the beneficiary's dementia and co-occurring conditions. CMS will provide GUIDE Individuals data related to the performance measures that CMS utilizes to identify the GUIDE Participant's performance-based change to the DCMP.GUIDE Participants in the recognized program track must be prepared to start providing services under the GUIDE Design on July 1, 2024, and bill for those services throughout the Model Efficiency Duration.

Yes, GUIDE beneficiary and supplier overlap with the Shared Savings Program is allowed. The GUIDE Design is developed to be compatible with other CMS designs and programs that intend to improve care and decrease costs. CMS thinks targeted support for individuals with dementia and their caregivers will assist improve population-based care outcomes overall.

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The Dementia Care Management Payment (DCMP), the per recipient monthly GUIDE payment, will be included in 2024 Shared Cost savings Program expenditures. When 2024 becomes a benchmark year, DCMPs will be consisted of in Shared Cost savings Program criteria computations. As an example, if an ACO is participating in both the GUIDE Model and the Shared Cost Savings Program during Performance Year 2024 and then restores and starts a new agreement period since 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 Respite Service claims will not be counted towards ACO expenses, shared savings, nor benchmarking start in 2024 for the period of the GUIDE Design.

GUIDE Individuals may take part in multiple CMS Innovation Center designs or Medicare value-based care efforts to accelerate innovation in care shipment, reduce the cost of care, and improve population health. Participants and recipients are qualified to get involved in the GUIDE Model and the ACO REACH Model. 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 cost of care expenditures or estimation of shared savings/shared losses.

Overlapping participants should follow GUIDE billing guidance as stated below. ACO REACH claim reductions will not use to DCMP. ACO REACH will consist of DCMP expenses for purposes of alignment estimations. Nevertheless, GUIDE Reprieve Service claims will not count toward ACO expenditures, shared cost savings, or benchmarking in 2025 and throughout of the GUIDE Design.

Since January 1, 2025, GUIDE Individuals likewise taking part in ACO REACH should terminate billing the Medicare Physician Cost Arrange Solutions consisted of under the DCMP (See Exhibition 5 in the GUIDE Payment Approach Paper (PDF)). Participants getting involved in both designs should follow the GUIDE billing requirements in the GUIDE Participation Agreement and GUIDE Payment Methodology Paper.

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The GUIDE Individual need to not bill Medicare independently for the services offered in the comprehensive evaluation. The comprehensive 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 proper Medicare-covered professional service that corresponds to the services rendered.