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Nevertheless, GUIDE Individuals have the choice, and are not required, to provide break through an adult day center or a 24-hour center. Additional GUIDE Break Services requirements and details surrounding the payment for such services are defined in the Participation Arrangement. GUIDE Participants in the brand-new program track that are categorized as safeguard service providers will be eligible to receive a one-time infrastructure payment of $75,000 (geographically adjusted by the Geographic Modification Element [GAF] to cover some of the in advance costs of establishing a brand-new dementia care program.

The facilities payment is planned for companies who wish to establish brand-new dementia care programs and need resources to start. GUIDE Individuals certified as a security net provider based on the percentage of their patient 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 security web provider, a brand-new program candidate should have had a Medicare FFS beneficiary population consisted of at least 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 break services will undergo recipient cost-sharing.

When a lined up beneficiary is re-assessed and designated to a brand-new tier, the GUIDE Individual will be eligible to bill the G-code for the recognized patient payment rate related to that tier the following month. GUIDE Individuals that withdraw or are terminated before the start of the 2nd performance year will be needed to repay the entire worth of their infrastructure payment to CMS.

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After the second performance year, GUIDE Individuals that withdraw or are terminated from the GUIDE Design are not needed to repay the facilities payment. The main design 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 Doctor Fee Schedule (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 Model is not a total-cost-of-care model, so GUIDE Individuals will continue to costs under standard 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 available in the Ask for Applications (Table 8, pg. 35). CMS may include or remove codes over time to reflect changes in PFS billing codes.

The care team may include the recipient's main care provider, and if not, the care team is required to recognize and share details with the beneficiary's medical care provider and experts and describe the care coordination services required to handle the recipient's dementia and co-occurring conditions. CMS will supply GUIDE Individuals data related to the efficiency measures that CMS utilizes to determine 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 Design on July 1, 2024, and bill for those services throughout the Design Performance Period.

Yes, GUIDE beneficiary and supplier overlap with the Shared Savings Program is permitted. The GUIDE Model is created to be suitable with other CMS designs and programs that intend to improve care and lower costs. CMS believes targeted assistance for individuals with dementia and their caretakers will assist improve population-based care results overall.

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The Dementia Care Management Payment (DCMP), the per beneficiary each month GUIDE payment, will be consisted of in 2024 Shared Cost savings Program expenses. When 2024 ends up being a benchmark year, DCMPs will be consisted of in Shared Cost savings Program criteria computations. As an example, if an ACO is getting involved in both the GUIDE Model and the Shared Cost Savings Program throughout Performance Year 2024 and after that renews and begins a brand-new contract period as of January 1, 2025, that ACO would have their Shared Cost savings Program benchmark 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 savings, nor benchmarking start in 2024 for the period of the GUIDE Model.

GUIDE Individuals may take part in multiple CMS Innovation Center designs or Medicare value-based care initiatives to speed up innovation in care shipment, lower the expense of care, and enhance population health. Individuals and beneficiaries 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 claims in the REACH ACOs' total cost of care expenses or estimation of shared savings/shared losses.

Overlapping individuals ought to follow GUIDE billing assistance as stated below. ACO REACH claim decreases will not apply to DCMP. ACO REACH will include DCMP expenses for purposes of alignment calculations. Nevertheless, GUIDE Reprieve Service claims will not count towards 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 ought to discontinue billing the Medicare Physician Cost Schedule Services consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Methodology Paper (PDF)). Participants taking part in both designs must follow the GUIDE billing requirements in the GUIDE Participation Agreement and GUIDE Payment Approach Paper.

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The GUIDE Participant must not bill Medicare individually for the services provided in the detailed evaluation. The extensive assessment (and any re-assessments) is covered by the DCMP. If CMS determines the beneficiary is not eligible for the GUIDE Model, the GUIDE Participant can bill for a suitable Medicare-covered professional service that represents the services rendered.