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GUIDE Individuals have the choice, and are not needed, to make offered break through an adult day center or a 24-hour center. Extra GUIDE Respite Solutions requirements and information surrounding the payment for such services are defined in the Participation Contract.

The facilities payment is planned for service providers who want to establish new dementia care programs and need resources to get going. GUIDE Participants certified as a security net supplier based on the proportion of their client population that is dually qualified for Medicare and Medicaid or get the Part D low-income aid.

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To qualify as a GUIDE safeguard company, a new program candidate should have had a Medicare FFS beneficiary population consisted of a minimum of 36% beneficiaries getting the Part D low-income aid 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 respite services will undergo beneficiary cost-sharing.

When an aligned beneficiary is re-assessed and designated to a new tier, the GUIDE Participant will be eligible to bill the G-code for the recognized client payment rate associated with that tier the following month. GUIDE Individuals that withdraw or are terminated before the start of the second performance year will be required to repay the entire value of their infrastructure payment to CMS.

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After the second efficiency year, GUIDE Participants that withdraw or are terminated from the GUIDE Model are not needed to repay the infrastructure payment. The main 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 Schedule (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 Model is not a total-cost-of-care design, so GUIDE Participants will continue to bill under traditional Medicare fee-for-service for all services that are not included under the DCMP. Additional details, consisting of a complete list of duplicative codes, is readily available in the Ask for Applications (Table 8, pg. 35). CMS may include or eliminate codes over time to show modifications in PFS billing codes.

The care group might consist of the beneficiary's primary care company, and if not, the care group is required to determine and share information with the beneficiary's primary care service provider and professionals and detail the care coordination services needed to manage the beneficiary's dementia and co-occurring conditions. CMS will offer GUIDE Individuals information related to the performance measures that CMS utilizes to figure out the GUIDE Individual's performance-based change to the DCMP.GUIDE Participants in the recognized program track should be prepared to begin providing services under the GUIDE Design on July 1, 2024, and costs for those services throughout the Model Performance Duration.

Yes, GUIDE beneficiary and provider overlap with the Shared Cost savings Program is enabled. The GUIDE Model is developed to be compatible with other CMS designs and programs that intend to enhance care and decrease costs. CMS believes targeted assistance for individuals with dementia and their caregivers will assist improve population-based care results overall.

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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 starts a brand-new agreement duration as of January 1, 2025, that ACO would have their Shared Savings Program benchmark based on 2022, 2023 and 2024, and would have DCMPs counted in Benchmark Year 3. GUIDE Respite 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 Participants might take part in numerous CMS Innovation Center models or Medicare value-based care initiatives to speed up innovation in care delivery, decrease the cost of care, and enhance population health. Individuals and recipients are qualified 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 estimation of shared savings/shared losses.

Overlapping participants should follow GUIDE billing guidance as set forth below. GUIDE Reprieve Service claims will not count towards ACO expenses, shared savings, or benchmarking in 2025 and for the period of the GUIDE Design.

Since January 1, 2025, GUIDE Individuals also taking part in ACO REACH ought to stop billing the Medicare Doctor Fee Set up Services consisted of under the DCMP (See Display 5 in the GUIDE Payment Methodology Paper (PDF)). Individuals taking part in both models must follow the GUIDE billing requirements in the GUIDE Participation Contract and GUIDE Payment Approach Paper.

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The GUIDE Individual must not bill Medicare independently for the services provided in the detailed evaluation. The detailed assessment (and any re-assessments) is covered by the DCMP. If CMS identifies the beneficiary is not eligible for the GUIDE Design, the GUIDE Participant can bill for an appropriate Medicare-covered expert service that represents the services rendered.