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However, GUIDE Participants have the choice, and are not required, to provide reprieve through an adult day center or a 24-hour center. Extra GUIDE Respite Services requirements and information surrounding the payment for such services are specified in the Participation Agreement. GUIDE Participants in the brand-new program track that are classified as safeguard providers will be eligible to receive a one-time infrastructure payment of $75,000 (geographically adjusted by the Geographic Modification Aspect [GAF] to cover a few of the in advance expenses of establishing a new dementia care program.

The infrastructure payment is intended for companies who wish to establish new dementia care programs and need resources to begin. GUIDE Individuals certified as a safety net supplier based upon the percentage of their client population that is dually qualified for Medicare and Medicaid or get the Part D low-income aid.

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To qualify as a GUIDE security internet company, a new program applicant need to have had a Medicare FFS beneficiary population made up of a minimum of 36% beneficiaries receiving the Part D low-income aid or 33.7% recipients who are dually eligible for Medicare and Medicaid. Accepting the facilities payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE break services will go through recipient cost-sharing.

When an aligned recipient is re-assessed and appointed to a brand-new tier, the GUIDE Participant will be eligible to bill the G-code for the recognized patient payment rate connected with that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the 2nd performance year will be required to repay the entire worth of their facilities payment to CMS.

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After the second performance year, GUIDE Participants that withdraw or are terminated from the GUIDE Model are not required 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 Cost Arrange (PFS) services, including persistent care management and principal care management, transitional care management, advance care preparation, and technology-based check-ins.

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The GUIDE Design 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. Additional information, including a complete list of duplicative codes, is available in the Request for Applications (Table 8, pg. 35). CMS may include or remove codes gradually to reflect modifications in PFS billing codes.

The care team may consist of the beneficiary's medical care service provider, and if not, the care team is required to recognize and share information with the beneficiary's medical care service provider and experts and outline the care coordination services required to manage the beneficiary's dementia and co-occurring conditions. CMS will provide GUIDE Participants information related to the efficiency measures that CMS utilizes to figure out the GUIDE Participant's performance-based adjustment to the DCMP.GUIDE Participants in the recognized program track ought to be prepared to start providing services under the GUIDE Model on July 1, 2024, and bill for those services during the Model Efficiency Duration.

Yes, GUIDE recipient and company overlap with the Shared Savings Program is enabled. The GUIDE Model is designed to be compatible with other CMS models and programs that aim to improve care and lower spending. CMS thinks targeted support for individuals with dementia and their caregivers will assist improve population-based care outcomes in general.

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As an example, if an ACO is taking part in both the GUIDE Design and the Shared Savings Program during Performance Year 2024 and then restores and starts a new agreement period as of January 1, 2025, that ACO would have their Shared Cost savings Program criteria based on 2022, 2023 and 2024, and would have DCMPs counted in Criteria Year 3. GUIDE Reprieve Service claims will not be counted towards ACO expenditures, shared cost savings, nor benchmarking start in 2024 for the duration of the GUIDE Design.

GUIDE Individuals might participate in several CMS Innovation Center models or Medicare value-based care efforts to accelerate innovation in care delivery, lower the expense of care, and improve population health. Participants and beneficiaries are eligible to take part in the GUIDE Design and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not consist of the Dementia Care Management Payment (DCMP) or Respite Service declares in the REACH ACOs' total cost of care expenses or calculation of shared savings/shared losses.

Overlapping individuals should follow GUIDE billing guidance as stated listed below. ACO REACH claim decreases will not apply to DCMP. ACO REACH will include DCMP expenditures for functions of alignment calculations. GUIDE Respite Service claims will not count toward ACO expenses, shared savings, or benchmarking in 2025 and for the period of the GUIDE Design.

Since January 1, 2025, GUIDE Participants also taking part in ACO REACH ought to stop billing the Medicare Physician Cost Schedule Services included under the DCMP (See Display 5 in the GUIDE Payment Methodology Paper (PDF)). Participants participating in both designs must follow the GUIDE billing requirements in the GUIDE Involvement Arrangement and GUIDE Payment Methodology Paper.

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The GUIDE Participant should not bill Medicare independently for the services offered in the extensive evaluation. The detailed evaluation (and any re-assessments) is covered by the DCMP. If CMS identifies the recipient is not qualified for the GUIDE Design, the GUIDE Participant can bill for a proper Medicare-covered expert service that corresponds to the services rendered.