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GUIDE Participants have the alternative, and are not needed, to make available break through an adult day center or a 24-hour facility. Additional GUIDE Reprieve Services requirements and information surrounding the payment for such services are specified in the Participation Agreement.

The facilities payment is intended for companies who want to develop new dementia care programs and require resources to get going. GUIDE Individuals qualified as a security net company based on the proportion of their patient population that is dually eligible for Medicare and Medicaid or receive the Part D low-income aid.

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To qualify as a GUIDE safety net company, a brand-new program candidate need to have had a Medicare FFS beneficiary population consisted of a minimum of 36% beneficiaries getting 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 go through recipient cost-sharing.

When an aligned beneficiary is re-assessed and assigned to a new tier, the GUIDE Individual will be eligible to bill the G-code for the established client payment rate connected with that tier the following month. GUIDE Participants that withdraw or are ended before the start of the second efficiency year will be required to repay the whole worth of their facilities 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 repay the infrastructure 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 change fee-for-service payment for some existing Medicare Doctor Cost Arrange (PFS) services, including persistent care management and primary care management, transitional care management, advance care planning, and technology-based check-ins.

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The GUIDE Model is not a total-cost-of-care model, so GUIDE Participants will continue to expense under conventional Medicare fee-for-service for all services that are not consisted of under the DCMP. CMS may add or eliminate codes over time to reflect modifications in PFS billing codes.

The care team might include the recipient's primary care supplier, and if not, the care group is needed to identify and share information with the recipient's primary care company and professionals and lay out the care coordination services needed to manage the recipient's dementia and co-occurring conditions. CMS will provide GUIDE Participants information connected to the performance determines that CMS utilizes to identify the GUIDE Participant's performance-based adjustment to the DCMP.GUIDE Individuals in the recognized program track must be prepared to start providing services under the GUIDE Model on July 1, 2024, and expense for those services during the Design Performance Duration.

Yes, GUIDE beneficiary and supplier overlap with the Shared Cost savings Program is permitted. The GUIDE Model is designed to be suitable with other CMS models and programs that intend to improve care and decrease spending. CMS believes targeted assistance for people with dementia and their caretakers will assist enhance population-based care results 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 Efficiency Year 2024 and then renews and starts a new contract duration 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 Break Service claims will not be counted towards ACO expenditures, shared savings, nor benchmarking beginning in 2024 for the duration of the GUIDE Design.

GUIDE Individuals may take part in several CMS Innovation Center models or Medicare value-based care initiatives to accelerate innovation in care delivery, decrease the expense of care, and enhance population health. Participants and recipients are qualified to participate 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 Break Service declares in the REACH ACOs' total cost of care expenditures or computation of shared savings/shared losses.

Overlapping participants ought to follow GUIDE billing guidance as set forth below. GUIDE Break Service claims will not count towards ACO expenditures, shared savings, or benchmarking in 2025 and for the period of the GUIDE Model.

As of January 1, 2025, GUIDE Participants also taking part in ACO REACH should terminate billing the Medicare Doctor Charge Schedule Providers consisted of under the DCMP (See Display 5 in the GUIDE Payment Approach Paper (PDF)). Participants taking part in both designs need to follow the GUIDE billing requirements in the GUIDE Participation Arrangement and GUIDE Payment Approach Paper.

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The GUIDE Individual need to not bill Medicare separately for the services provided in the extensive assessment. The detailed assessment (and any re-assessments) is covered by the DCMP. If CMS identifies the recipient is not eligible for the GUIDE Design, the GUIDE Individual can bill for a suitable Medicare-covered professional service that represents the services rendered.