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GUIDE Participants have the alternative, and are not needed, to make offered break through an adult day center or a 24-hour facility. Additional GUIDE Reprieve Providers requirements and details surrounding the payment for such services are defined in the Involvement Agreement.

The infrastructure payment is planned for companies who wish to develop brand-new dementia care programs and require resources to begin. GUIDE Participants qualified as a safety net company based upon the percentage 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 supplier, a new program candidate should have had a Medicare FFS beneficiary population comprised of at least 36% recipients receiving 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 break services will be subject to beneficiary cost-sharing.

When a lined up recipient is re-assessed and appointed to a new tier, the GUIDE Individual will be qualified to bill the G-code for the established patient payment rate associated with that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the second efficiency year will be required to repay the entire worth of their infrastructure payment to CMS.

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After the 2nd efficiency year, GUIDE Individuals that withdraw or are ended from the GUIDE Design are not needed to repay 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 Physician Fee Schedule (PFS) services, consisting of chronic 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 Individuals will continue to costs under conventional Medicare fee-for-service for all services that are not consisted of under the DCMP. CMS may include or get rid of codes over time to show modifications in PFS billing codes.

The care group may include the recipient's medical care supplier, and if not, the care group is required to determine and share info with the recipient's medical care service provider and experts and outline the care coordination services needed to handle the recipient's dementia and co-occurring conditions. CMS will provide GUIDE Individuals information related to the efficiency determines that CMS utilizes to identify the GUIDE Individual's performance-based modification to the DCMP.GUIDE Participants in the recognized program track should be prepared to start providing services under the GUIDE Design on July 1, 2024, and costs for those services throughout the Model Efficiency Duration.

Yes, GUIDE beneficiary and service provider overlap with the Shared Savings Program is allowed. The GUIDE Model is developed to be compatible with other CMS designs and programs that aim to improve care and lower spending. CMS believes targeted assistance for individuals with dementia and their caregivers will help improve population-based care outcomes in general.

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The Dementia Care Management Payment (DCMP), the per beneficiary monthly GUIDE payment, will be included in 2024 Shared Savings Program expenses. When 2024 becomes a benchmark year, DCMPs will be consisted of in Shared Savings Program criteria calculations. As an example, if an ACO is getting involved in both the GUIDE Model and the Shared Cost Savings Program during Performance Year 2024 and then restores and starts a new arrangement period as of January 1, 2025, that ACO would have their Shared Savings Program criteria based upon 2022, 2023 and 2024, and would have DCMPs counted in Standard Year 3. Nevertheless, GUIDE Break Service claims will not be counted towards ACO expenditures, shared cost savings, nor benchmarking beginning in 2024 throughout of the GUIDE Model.

GUIDE Participants might participate in multiple CMS Development Center designs or Medicare value-based care initiatives to speed up development in care delivery, minimize the cost of care, and enhance population health. Participants and beneficiaries are qualified to take part 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 claims in the REACH ACOs' total cost of care expenditures or estimation of shared savings/shared losses.

Overlapping individuals need to follow GUIDE billing guidance as stated below. ACO REACH claim decreases will not use to DCMP. ACO REACH will consist of DCMP expenditures for purposes of positioning estimations. However, GUIDE Respite Service claims will not count toward ACO expenses, shared cost savings, or benchmarking in 2025 and for the period of the GUIDE Model.

Since January 1, 2025, GUIDE Participants also taking part in ACO REACH should stop billing the Medicare Physician Fee Set up Providers consisted of under the DCMP (See Display 5 in the GUIDE Payment Methodology Paper (PDF)). Individuals taking part in both designs should follow the GUIDE billing requirements in the GUIDE Involvement Contract and GUIDE Payment Methodology Paper.

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The GUIDE Individual must not bill Medicare independently for the services offered in the detailed assessment. The detailed evaluation (and any re-assessments) is covered by the DCMP. If CMS figures out the recipient is not qualified for the GUIDE Design, the GUIDE Participant can bill for an appropriate Medicare-covered professional service that corresponds to the services rendered.