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GUIDE Individuals have the choice, and are not required, to make offered reprieve through an adult day center or a 24-hour center. Additional GUIDE Respite Providers requirements and details surrounding the payment for such services are specified in the Participation Arrangement.

The infrastructure payment is meant for suppliers who wish to develop brand-new dementia care programs and need resources to get going. GUIDE Individuals certified as a security net service provider based on the proportion 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 safeguard company, a new program candidate must have had a Medicare FFS beneficiary population comprised of a minimum of 36% beneficiaries getting the Part D low-income aid or 33.7% recipients who are dually qualified for Medicare and Medicaid. Accepting the infrastructure 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 appointed to a brand-new tier, the GUIDE Participant 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 terminated before the start of the 2nd performance year will be needed to repay the entire worth of their facilities payment to CMS.

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After the 2nd performance year, GUIDE Participants that withdraw or are ended from the GUIDE Design 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 replace fee-for-service payment for some existing Medicare Doctor Fee Arrange (PFS) services, consisting of persistent care management and principal 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 design, so GUIDE Individuals will continue to expense under traditional Medicare fee-for-service for all services that are not consisted of under the DCMP. Additional information, consisting of a complete list of duplicative codes, is readily available in the Demand for Applications (Table 8, pg. 35). CMS might add or get rid of codes over time to reflect modifications in PFS billing codes.

The care team might consist of the beneficiary's medical care supplier, and if not, the care team is needed to determine and share information with the recipient's medical care company and professionals and lay out the care coordination services needed to handle the recipient's dementia and co-occurring conditions. CMS will offer GUIDE Participants information associated with the performance measures that CMS utilizes to figure out the GUIDE Individual's performance-based modification to the DCMP.GUIDE Participants in the established program track must be prepared to begin furnishing services under the GUIDE Design on July 1, 2024, and bill for those services throughout the Model Efficiency Period.

Yes, GUIDE recipient and service provider overlap with the Shared Savings Program is allowed. The GUIDE Model is designed to be compatible with other CMS designs and programs that intend to improve care and decrease costs. CMS believes targeted support for individuals with dementia and their caregivers will assist enhance 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 Savings Program during Efficiency Year 2024 and then renews and begins a new agreement 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 Benchmark Year 3. GUIDE Reprieve Service claims will not be counted toward ACO expenses, shared savings, nor benchmarking beginning in 2024 for the period of the GUIDE Design.

GUIDE Participants may take part in multiple CMS Development Center models or Medicare value-based care efforts to speed up innovation in care delivery, reduce the cost of care, and improve population health. Participants and recipients are eligible to take part in the GUIDE Design and the ACO REACH Model. For the rest of CY 2024, ACO REACH will not consist of the Dementia Care Management Payment (DCMP) or Reprieve Service claims in the REACH ACOs' total cost of care expenditures or computation of shared savings/shared losses.

Overlapping participants need to follow GUIDE billing guidance as set forth below. GUIDE Respite Service claims will not count toward 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 need to discontinue billing the Medicare Doctor Charge Arrange Solutions included under the DCMP (See Exhibition 5 in the GUIDE Payment Methodology Paper (PDF)). Individuals taking part in both models should follow the GUIDE billing requirements in the GUIDE Participation Agreement and GUIDE Payment Method Paper.

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The GUIDE Participant need to not bill Medicare individually for the services provided in the comprehensive assessment. The thorough evaluation (and any re-assessments) is covered by the DCMP. If CMS figures out the beneficiary is not qualified for the GUIDE Design, the GUIDE Participant can bill for a suitable Medicare-covered expert service that corresponds to the services rendered.