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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 facility. Additional GUIDE Break Services requirements and details surrounding the payment for such services are defined in the Participation Arrangement.

The infrastructure payment is meant for suppliers who desire to establish brand-new dementia care programs and require resources to get begun. GUIDE Participants qualified as a security net company based upon the proportion of their client population that is dually qualified 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 brand-new program applicant should have had a Medicare FFS beneficiary population made up of a minimum of 36% beneficiaries 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 respite services will undergo recipient cost-sharing.

When a lined up beneficiary is re-assessed and designated to a new tier, the GUIDE Individual will be eligible to bill the G-code for the recognized client payment rate connected with that tier the following month. GUIDE Participants that withdraw or are ended before the start of the 2nd performance year will be needed to pay back the whole value of their infrastructure payment to CMS.

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After the 2nd performance year, GUIDE Individuals that withdraw or are ended from the GUIDE Model are not required to repay the facilities 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 replace fee-for-service payment for some existing Medicare Doctor Charge Schedule (PFS) services, including persistent 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 design, so GUIDE Individuals will continue to expense under conventional Medicare fee-for-service for all services that are not included under the DCMP. Additional details, including a complete list of duplicative codes, is offered in the Ask for Applications (Table 8, pg. 35). CMS may add or get rid of codes over time to reflect changes in PFS billing codes.

The care group might include the recipient's medical care provider, and if not, the care team is needed to determine and share info with the beneficiary's main care provider and experts and detail the care coordination services required to manage the beneficiary's dementia and co-occurring conditions. CMS will offer GUIDE Participants data related to the performance measures that CMS uses to determine the GUIDE Individual's performance-based adjustment to the DCMP.GUIDE Participants in the recognized program track need to be prepared to start providing services under the GUIDE Model on July 1, 2024, and bill for those services during the Design Efficiency Period.

Yes, GUIDE recipient and company overlap with the Shared Savings Program is enabled. The GUIDE Design is developed to be suitable with other CMS models and programs that aim to improve care and reduce spending. CMS believes targeted support for people with dementia and their caretakers will assist improve population-based care outcomes in general.

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As an example, if an ACO is participating in both the GUIDE Design and the Shared Savings Program during Efficiency Year 2024 and then restores and starts a new arrangement period 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 Respite Service claims will not be counted towards ACO expenses, shared savings, nor benchmarking beginning in 2024 for the duration of the GUIDE Design.

GUIDE Participants may take part in multiple CMS Development Center models or Medicare value-based care efforts to accelerate development in care shipment, lower the expense of care, and enhance population health. Participants and beneficiaries are eligible to get involved 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 Break Service declares in the REACH ACOs' total expense of care expenditures or estimation of shared savings/shared losses.

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

Since January 1, 2025, GUIDE Individuals also taking part in ACO REACH ought to cease billing the Medicare Physician Cost Set up Services included under the DCMP (See Display 5 in the GUIDE Payment Approach Paper (PDF)). Participants 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 should not bill Medicare independently for the services provided in the detailed 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 Model, the GUIDE Individual can bill for a proper Medicare-covered expert service that corresponds to the services rendered.