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Nevertheless, GUIDE Participants have the option, and are not required, to make available respite through an adult day center or a 24-hour center. Additional GUIDE Break Providers requirements and details surrounding the payment for such services are defined in the Participation Contract. GUIDE Individuals in the new program track that are classified as safeguard service providers will be qualified to get a one-time infrastructure payment of $75,000 (geographically changed by the Geographic Change Factor [GAF] to cover a few of the upfront expenses of establishing a new dementia care program.

The facilities payment is intended for companies who want to develop new dementia care programs and need resources to get begun. GUIDE Individuals certified as a security net provider based upon the proportion of their patient population that is dually eligible for Medicare and Medicaid or get the Part D low-income subsidy.

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To qualify as a GUIDE safeguard supplier, a brand-new program candidate must have had a Medicare FFS recipient population consisted of at least 36% beneficiaries getting 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 undergo recipient cost-sharing.

When a lined up recipient is re-assessed and appointed to a brand-new tier, the GUIDE Participant will be eligible to bill the G-code for the recognized patient payment rate associated with that tier the following month. GUIDE Participants that withdraw or are ended before the start of the second performance year will be required to repay the entire value of their facilities payment to CMS.

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After the 2nd performance year, GUIDE Individuals that withdraw or are terminated from the GUIDE Model are not required to pay back the infrastructure payment. The primary 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 Set Up (PFS) services, including persistent care management and primary care management, transitional care management, advance care preparation, 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 costs under traditional Medicare fee-for-service for all services that are not included under the DCMP. CMS may include or eliminate codes over time to show modifications in PFS billing codes.

The care group may include the beneficiary's medical care service provider, and if not, the care team is needed to recognize and share information with the recipient's medical care supplier and professionals and outline the care coordination services required to manage the beneficiary's dementia and co-occurring conditions. CMS will supply GUIDE Individuals data connected to the efficiency determines that CMS utilizes to identify the GUIDE Individual's performance-based adjustment to the DCMP.GUIDE Participants in the recognized program track should be prepared to start furnishing services under the GUIDE Design on July 1, 2024, and bill for those services throughout the Design Efficiency Period.

Yes, GUIDE beneficiary and service provider overlap with the Shared Cost savings Program is allowed. The GUIDE Design is developed to be compatible with other CMS designs and programs that aim to improve care and decrease costs. CMS thinks targeted assistance for individuals with dementia and their caretakers will help improve population-based care outcomes in general.

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As an example, if an ACO is taking part in both the GUIDE Model and the Shared Savings Program throughout Efficiency Year 2024 and then restores and begins a brand-new contract duration as of January 1, 2025, that ACO would have their Shared 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 towards ACO expenses, shared cost savings, nor benchmarking start in 2024 for the duration of the GUIDE Design.

GUIDE Participants may participate in multiple CMS Development Center models or Medicare value-based care initiatives to speed up innovation in care shipment, minimize the cost of care, and enhance population health. Individuals 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 consist of the Dementia Care Management Payment (DCMP) or Break Service declares in the REACH ACOs' overall expense of care expenses or estimation of shared savings/shared losses.

Overlapping individuals must follow GUIDE billing guidance as stated listed below. ACO REACH claim reductions will not use to DCMP. ACO REACH will consist of DCMP expenditures for purposes of positioning calculations. GUIDE Reprieve Service claims will not count toward ACO expenditures, shared cost savings, or benchmarking in 2025 and for the duration of the GUIDE Design.

As of January 1, 2025, GUIDE Individuals also taking part in ACO REACH need to cease billing the Medicare Physician Charge Arrange Providers included under the DCMP (See Exhibit 5 in the GUIDE Payment Methodology Paper (PDF)). Participants taking part in both designs need to follow the GUIDE billing requirements in the GUIDE Involvement Arrangement and GUIDE Payment Methodology Paper.

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The GUIDE Participant need to not bill Medicare independently for the services offered in the thorough evaluation. The extensive assessment (and any re-assessments) is covered by the DCMP. If CMS determines the recipient is not eligible for the GUIDE Design, the GUIDE Individual can bill for a suitable Medicare-covered expert service that represents the services rendered.