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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 Respite Services requirements and details surrounding the payment for such services are specified in the Participation Contract.

The infrastructure payment is meant for companies who wish to develop new dementia care programs and need resources to get going. GUIDE Individuals qualified as a security net service provider based upon the proportion of their patient population that is dually qualified for Medicare and Medicaid or get the Part D low-income subsidy.

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To certify as a GUIDE security net service provider, a new program candidate need to have had a Medicare FFS beneficiary population consisted of at least 36% recipients receiving 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 reprieve services will be subject to beneficiary cost-sharing.

When a lined up beneficiary is re-assessed and assigned to a new tier, the GUIDE Individual will be eligible to bill the G-code for the established patient payment rate related to that tier the following month. GUIDE Participants that withdraw or are ended before the start of the 2nd performance year will be needed to pay back the whole worth of their facilities payment to CMS.

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After the 2nd efficiency year, GUIDE Individuals that withdraw or are terminated from the GUIDE Design are not required to repay 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 Charge Schedule (PFS) services, consisting of chronic care management and principal 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 bill under conventional Medicare fee-for-service for all services that are not included under the DCMP. Extra details, consisting of a complete list of duplicative codes, is available in the Ask for Applications (Table 8, pg. 35). CMS might add or remove codes in time to reflect modifications in PFS billing codes.

The care team may include the recipient's primary care service provider, and if not, the care team is required to recognize and share information with the beneficiary's medical care company and specialists and lay out the care coordination services needed to manage the recipient's dementia and co-occurring conditions. CMS will supply GUIDE Individuals information associated with the performance determines that CMS utilizes to identify the GUIDE Individual's performance-based adjustment to the DCMP.GUIDE Participants in the established program track need to be prepared to start furnishing services under the GUIDE Design on July 1, 2024, and bill for those services throughout the Design Efficiency Duration.

Yes, GUIDE beneficiary and provider overlap with the Shared Cost savings Program is permitted. The GUIDE Model is developed to be suitable with other CMS models and programs that aim to enhance care and decrease spending. CMS thinks targeted assistance for individuals with dementia and their caretakers will help 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 Savings Program during Performance Year 2024 and then renews and begins a brand-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 Criteria Year 3. GUIDE Reprieve Service claims will not be counted toward ACO expenditures, shared savings, nor benchmarking start in 2024 for the period of the GUIDE Model.

GUIDE Individuals may take part in several CMS Innovation Center designs or Medicare value-based care initiatives to speed up development in care shipment, minimize the cost of care, and improve population health. Participants and beneficiaries are qualified to take part in the GUIDE Design 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' total cost of care expenses or calculation of shared savings/shared losses.

Overlapping individuals ought to follow GUIDE billing assistance as stated below. ACO REACH claim reductions will not use to DCMP. ACO REACH will consist of DCMP expenses for purposes of alignment computations. However, GUIDE Reprieve Service claims will not count towards ACO expenses, shared savings, or benchmarking in 2025 and for the period of the GUIDE Model.

Since January 1, 2025, GUIDE Individuals likewise taking part in ACO REACH must terminate billing the Medicare Doctor Cost Arrange Services included under the DCMP (See Exhibit 5 in the GUIDE Payment Methodology Paper (PDF)). Participants taking part in both models must follow the GUIDE billing requirements in the GUIDE Participation Contract and GUIDE Payment Method Paper.

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The GUIDE Participant need to not bill Medicare separately for the services supplied in the comprehensive assessment. The extensive evaluation (and any re-assessments) is covered by the DCMP. If CMS figures out the recipient is not eligible for the GUIDE Design, the GUIDE Individual can bill for an appropriate Medicare-covered expert service that represents the services rendered.