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GUIDE Individuals have the choice, and are not required, to make readily available break through an adult day center or a 24-hour center. Extra GUIDE Respite Solutions requirements and details surrounding the payment for such services are defined in the Involvement Arrangement.

The facilities payment is intended for providers who wish to develop new dementia care programs and require resources to begin. GUIDE Participants qualified as a safeguard supplier based upon the percentage of their patient population that is dually qualified for Medicare and Medicaid or receive the Part D low-income aid.

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To certify as a GUIDE safeguard service provider, a brand-new program applicant need to have had a Medicare FFS recipient population consisted of a minimum of 36% recipients getting the Part D low-income subsidy or 33.7% recipients 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 undergo recipient cost-sharing.

When an aligned recipient is re-assessed and appointed to a 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 Individuals that withdraw or are terminated before the start of the 2nd efficiency year will be required to repay the entire worth 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 Design are not needed to repay the facilities payment. The main 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 Fee Arrange (PFS) services, consisting of 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 expense under traditional Medicare fee-for-service for all services that are not included under the DCMP. CMS may add or eliminate codes over time to reflect changes in PFS billing codes.

The care group might consist of the beneficiary's main care service provider, and if not, the care group is needed to recognize and share information with the beneficiary's medical care service provider and experts and lay out the care coordination services required to handle the beneficiary's dementia and co-occurring conditions. CMS will offer GUIDE Participants information related to the efficiency measures that CMS uses to figure out the GUIDE Participant's performance-based adjustment to the DCMP.GUIDE Individuals in the recognized program track must be prepared to begin furnishing services under the GUIDE Model on July 1, 2024, and costs for those services during the Design Efficiency Period.

Yes, GUIDE beneficiary and provider overlap with the Shared Cost savings Program is enabled. The GUIDE Design is developed to be compatible with other CMS models and programs that intend to enhance care and lower spending. CMS thinks targeted assistance for people with dementia and their caregivers will assist improve population-based care outcomes in general.

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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 restores and begins a 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 Criteria Year 3. GUIDE Reprieve Service claims will not be counted toward ACO expenditures, shared cost savings, nor benchmarking start in 2024 for the duration of the GUIDE Design.

GUIDE Individuals may take part in several CMS Innovation Center designs or Medicare value-based care efforts to accelerate innovation in care shipment, minimize the expense of care, and improve population health. Individuals and recipients are eligible to take part in the GUIDE Model and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not include the Dementia Care Management Payment (DCMP) or Break Service declares in the REACH ACOs' total cost of care expenditures or calculation of shared savings/shared losses.

Overlapping individuals should follow GUIDE billing guidance as set forth listed below. GUIDE Reprieve Service claims will not count towards ACO expenditures, shared 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 must stop billing the Medicare Physician Fee Schedule Solutions consisted of under the DCMP (See Display 5 in the GUIDE Payment Approach Paper (PDF)). Participants taking part in both models must follow the GUIDE billing requirements in the GUIDE Involvement Arrangement and GUIDE Payment Method Paper.

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The GUIDE Participant must not bill Medicare individually for the services provided in the extensive evaluation. The thorough evaluation (and any re-assessments) is covered by the DCMP. If CMS determines the recipient is not qualified for the GUIDE Design, the GUIDE Individual can bill for an appropriate Medicare-covered professional service that represents the services rendered.