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GUIDE Participants have the option, and are not required, to make offered break through an adult day center or a 24-hour center. Extra GUIDE Break Services requirements and information surrounding the payment for such services are defined in the Participation Agreement.

The facilities payment is intended for providers who want to develop new dementia care programs and need resources to start. GUIDE Participants certified as a safeguard supplier based upon the proportion of their client population that is dually eligible for Medicare and Medicaid or receive the Part D low-income subsidy.

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To qualify as a GUIDE safety net company, a brand-new program applicant must have had a Medicare FFS recipient population comprised 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 infrastructure payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE respite services will go through recipient cost-sharing.

When a lined up recipient is re-assessed and assigned to a brand-new tier, the GUIDE Individual will be eligible 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 pay back the whole value of their infrastructure payment to CMS.

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After the 2nd efficiency year, GUIDE Participants that withdraw or are terminated from the GUIDE Design are not needed to pay back the infrastructure payment. The primary design payment under the GUIDE Design 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 Charge Arrange (PFS) services, including 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 Participants will continue to bill under standard Medicare fee-for-service for all services that are not included under the DCMP. CMS might include or get rid of codes over time to reflect modifications in PFS billing codes.

The care group might include the beneficiary's main care company, and if not, the care group is needed to identify and share information with the beneficiary's main care company and professionals and describe the care coordination services required to manage the recipient's dementia and co-occurring conditions. CMS will provide GUIDE Participants information associated with the performance determines that CMS utilizes to figure out the GUIDE Participant's performance-based modification to the DCMP.GUIDE Participants in the established program track ought to be prepared to start providing services under the GUIDE Design on July 1, 2024, and costs for those services throughout the Model Performance Period.

Yes, GUIDE recipient and supplier overlap with the Shared Cost savings Program is allowed. The GUIDE Design is developed to be suitable with other CMS models and programs that aim to enhance care and minimize spending. CMS believes targeted support for people with dementia and their caretakers will assist improve population-based care results in general.

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As an example, if an ACO is getting involved in both the GUIDE Design and the Shared Savings Program throughout Efficiency Year 2024 and then restores and starts a brand-new arrangement duration 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 Benchmark Year 3. GUIDE Break Service claims will not be counted toward ACO expenses, shared cost savings, nor benchmarking start in 2024 for the duration of the GUIDE Design.

GUIDE Participants may take part in multiple CMS Development Center designs or Medicare value-based care initiatives to speed up development in care shipment, decrease the expense of care, and improve population health. Participants and recipients are qualified to participate in the GUIDE Model 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 expenditures or calculation of shared savings/shared losses.

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

As of January 1, 2025, GUIDE Individuals likewise getting involved in ACO REACH must terminate billing the Medicare Doctor Fee Set up Services consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Method Paper (PDF)). Individuals taking part in both designs should follow the GUIDE billing requirements in the GUIDE Involvement Contract and GUIDE Payment Approach Paper.

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The GUIDE Participant must not bill Medicare separately for the services offered in the thorough assessment. The comprehensive evaluation (and any re-assessments) is covered by the DCMP. If CMS determines the beneficiary is not qualified for the GUIDE Design, the GUIDE Participant can bill for a suitable Medicare-covered professional service that corresponds to the services rendered.