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GUIDE Individuals have the alternative, and are not needed, to make readily available reprieve through an adult day center or a 24-hour center. Extra GUIDE Reprieve Providers requirements and details surrounding the payment for such services are defined in the Participation Agreement.

The facilities payment is meant for service providers who want to develop brand-new dementia care programs and require resources to start. GUIDE Participants certified as a safety net provider based on the percentage of their client population that is dually eligible for Medicare and Medicaid or receive the Part D low-income aid.

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To certify as a GUIDE safety net service provider, a new program candidate must have had a Medicare FFS recipient population consisted of at least 36% beneficiaries receiving the Part D low-income subsidy 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 reprieve services will be subject to recipient cost-sharing.

When a lined up recipient is re-assessed and designated to a new tier, the GUIDE Participant will be qualified to bill the G-code for the recognized client payment rate related to that tier the following month. GUIDE Individuals that withdraw or are ended before the start of the second efficiency year will be needed to pay back the whole value of their infrastructure 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 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 Physician Charge Schedule (PFS) services, consisting of chronic 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 Participants will continue to expense under traditional Medicare fee-for-service for all services that are not included under the DCMP. CMS may include or get rid of codes over time to show changes in PFS billing codes.

The care group may consist of the beneficiary's main care provider, and if not, the care team is required to recognize and share details with the recipient's main care provider and specialists and lay out the care coordination services needed to manage the beneficiary's dementia and co-occurring conditions. CMS will provide GUIDE Participants information connected to the efficiency determines that CMS uses to determine the GUIDE Participant's performance-based adjustment to the DCMP.GUIDE Individuals in the recognized program track should be prepared to start providing services under the GUIDE Model on July 1, 2024, and costs for those services throughout the Design Performance Duration.

Yes, GUIDE recipient and provider overlap with the Shared Savings Program is allowed. The GUIDE Design is created to be suitable with other CMS designs and programs that intend to improve care and minimize costs. CMS thinks targeted support for individuals with dementia and their caregivers will help enhance population-based care results in general.

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The Dementia Care Management Payment (DCMP), the per recipient monthly GUIDE payment, will be consisted of in 2024 Shared Savings Program expenditures. When 2024 ends up being a benchmark year, DCMPs will be included in Shared Savings Program benchmark estimations. As an example, if an ACO is getting involved in both the GUIDE Design and the Shared Cost Savings Program throughout Efficiency Year 2024 and then renews and starts a brand-new arrangement period since January 1, 2025, that ACO would have their Shared Cost savings Program criteria based upon 2022, 2023 and 2024, and would have DCMPs counted in Standard Year 3. GUIDE Reprieve Service claims will not be counted toward ACO expenses, shared cost savings, nor benchmarking beginning in 2024 for the period of the GUIDE Design.

GUIDE Individuals may take part in numerous CMS Innovation Center designs or Medicare value-based care efforts to speed up development in care shipment, decrease the expense of care, and enhance population health. Participants and beneficiaries are eligible to take part in the GUIDE Model 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 claims in the REACH ACOs' total cost of care expenses or estimation of shared savings/shared losses.

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

As of January 1, 2025, GUIDE Individuals also taking part in ACO REACH need to stop billing the Medicare Physician Cost Schedule Services consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Approach Paper (PDF)). Participants participating in both designs should follow the GUIDE billing requirements in the GUIDE Involvement Arrangement and GUIDE Payment Approach Paper.

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The GUIDE Participant should not bill Medicare separately for the services provided in the extensive evaluation. The thorough assessment (and any re-assessments) is covered by the DCMP. If CMS identifies the beneficiary is not qualified for the GUIDE Design, the GUIDE Individual can bill for an appropriate Medicare-covered expert service that represents the services rendered.