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GUIDE Participants have the choice, and are not required, to make offered reprieve through an adult day center or a 24-hour facility. Additional GUIDE Reprieve Solutions requirements and information surrounding the payment for such services are defined in the Participation Arrangement. GUIDE Individuals in the brand-new program track that are categorized as safeguard companies will be qualified to receive a one-time infrastructure payment of $75,000 (geographically adjusted by the Geographic Adjustment Factor [GAF] to cover a few of the upfront expenses of developing a brand-new dementia care program.

The facilities payment is meant for companies who wish to develop new dementia care programs and need resources to start. GUIDE Participants qualified as a safety net 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 provider, a brand-new program applicant should have had a Medicare FFS recipient population consisted of a minimum of 36% recipients receiving the Part D low-income aid or 33.7% beneficiaries who are dually eligible 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 a lined up beneficiary is re-assessed and designated to a brand-new tier, the GUIDE Participant will be qualified to bill the G-code for the established client payment rate associated with that tier the following month. GUIDE Participants that withdraw or are ended before the start of the 2nd efficiency year will be needed to repay the entire value of their facilities payment to CMS.

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After the 2nd efficiency year, GUIDE Individuals that withdraw or are ended from the GUIDE Model are not needed to pay back the infrastructure payment. The primary 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 Schedule (PFS) services, consisting of persistent care management and primary 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 model, so GUIDE Individuals will continue to expense under conventional Medicare fee-for-service for all services that are not consisted of under the DCMP. Additional information, including a total list of duplicative codes, is offered in the Ask for Applications (Table 8, pg. 35). CMS may add or get rid of codes with time to reflect modifications in PFS billing codes.

The care group might consist of the beneficiary's medical care service provider, and if not, the care group is needed to determine and share information with the recipient's primary care provider and experts and detail the care coordination services required to manage the beneficiary's dementia and co-occurring conditions. CMS will provide GUIDE Participants data related to the performance measures that CMS uses to identify the GUIDE Participant's performance-based change to the DCMP.GUIDE Individuals in the established program track should be prepared to start providing 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 Savings Program is permitted. The GUIDE Model is designed to be compatible with other CMS models and programs that aim to enhance care and minimize spending. CMS thinks targeted assistance for individuals with dementia and their caregivers will assist enhance population-based care outcomes in general.

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As an example, if an ACO is participating in both the GUIDE Model and the Shared Savings Program throughout Efficiency Year 2024 and then restores and starts a new contract period as of January 1, 2025, that ACO would have their Shared Cost savings Program standard 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 expenses, shared cost savings, nor benchmarking beginning in 2024 for the duration of the GUIDE Design.

GUIDE Participants might take part in several CMS Development Center models or Medicare value-based care initiatives to accelerate innovation in care shipment, minimize the expense of care, and improve population health. Individuals and beneficiaries are qualified to take part in the GUIDE Design and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not include the Dementia Care Management Payment (DCMP) or Respite Service claims in the REACH ACOs' total cost of care expenditures or computation of shared savings/shared losses.

Overlapping individuals ought to follow GUIDE billing assistance as set forth below. ACO REACH claim reductions will not apply to DCMP. ACO REACH will consist of DCMP expenditures for purposes of alignment computations. However, 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 participating in ACO REACH need to discontinue billing the Medicare Doctor Fee Set up Solutions included under the DCMP (See Exhibition 5 in the GUIDE Payment Methodology Paper (PDF)). Individuals taking part in both designs should 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 individually for the services provided in the thorough assessment. The extensive assessment (and any re-assessments) is covered by the DCMP. If CMS figures out the beneficiary is not eligible for the GUIDE Design, the GUIDE Individual can bill for a proper Medicare-covered professional service that represents the services rendered.