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GUIDE Participants have the alternative, 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 defined in the Participation Contract. GUIDE Individuals in the new program track that are categorized as safeguard service providers will be eligible to get a one-time infrastructure payment of $75,000 (geographically changed by the Geographic Change Element [GAF] to cover some of the in advance expenses of developing a new dementia care program.

The infrastructure payment is meant for companies who desire to develop brand-new dementia care programs and require resources to begin. GUIDE Individuals certified as a safeguard service provider based on the percentage of their patient population that is dually eligible for Medicare and Medicaid or get the Part D low-income aid.

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To certify as a GUIDE safeguard supplier, a new program applicant must have had a Medicare FFS beneficiary population consisted of a minimum of 36% recipients receiving the Part D low-income aid 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 respite services will undergo beneficiary cost-sharing.

When an aligned recipient is re-assessed and appointed to a new tier, the GUIDE Participant will be qualified to bill the G-code for the established client payment rate related to that tier the following month. GUIDE Participants that withdraw or are ended before the start of the second performance year will be required to repay the entire worth 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 Design are not required to pay back the facilities payment. The main model 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 Cost Arrange (PFS) services, including chronic care management and primary 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 standard Medicare fee-for-service for all services that are not included under the DCMP. Additional info, consisting of a total list of duplicative codes, is offered in the Ask for Applications (Table 8, pg. 35). CMS might include or remove codes in time to show changes in PFS billing codes.

The care team might include the recipient's medical care company, and if not, the care group is needed to recognize and share info with the beneficiary's medical care supplier and experts and lay out the care coordination services needed to handle the beneficiary's dementia and co-occurring conditions. CMS will provide GUIDE Participants data connected to the efficiency determines that CMS utilizes to identify the GUIDE Individual's performance-based adjustment to the DCMP.GUIDE Individuals in the recognized program track should be prepared to start providing services under the GUIDE Design on July 1, 2024, and costs for those services throughout the Model Efficiency Period.

Yes, GUIDE recipient and supplier overlap with the Shared Cost savings Program is allowed. The GUIDE Model is developed to be suitable with other CMS models and programs that aim to enhance care and lower spending. CMS believes targeted assistance for individuals with dementia and their caregivers will assist improve population-based care outcomes overall.

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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 begins a new contract period as of January 1, 2025, that ACO would have their Shared Savings Program standard based on 2022, 2023 and 2024, and would have DCMPs counted in Standard Year 3. GUIDE Reprieve Service claims will not be counted towards ACO expenses, shared savings, nor benchmarking beginning in 2024 for the duration of the GUIDE Design.

GUIDE Individuals might take part in several CMS Development Center models or Medicare value-based care efforts to speed up development in care shipment, lower the expense of care, and enhance population health. Participants and beneficiaries are qualified to get involved 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' overall cost of care expenditures or computation of shared savings/shared losses.

Overlapping participants need to follow GUIDE billing assistance as set forth listed below. ACO REACH claim decreases will not use to DCMP. ACO REACH will consist of DCMP expenses for functions of positioning estimations. GUIDE Break Service claims will not count towards ACO expenses, shared savings, or benchmarking in 2025 and for the period of the GUIDE Model.

As of January 1, 2025, GUIDE Participants likewise taking part in ACO REACH should cease billing the Medicare Physician Charge Schedule Solutions consisted of under the DCMP (See Exhibition 5 in the GUIDE Payment Approach Paper (PDF)). Participants participating in both models must follow the GUIDE billing requirements in the GUIDE Involvement Contract and GUIDE Payment Approach Paper.

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The GUIDE Individual must not bill Medicare independently for the services provided in the thorough assessment. The detailed assessment (and any re-assessments) is covered by the DCMP. If CMS determines the beneficiary is not qualified for the GUIDE Design, the GUIDE Participant can bill for an appropriate Medicare-covered professional service that represents the services rendered.