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GUIDE Participants have the choice, and are not required, to make available break through an adult day center or a 24-hour facility. Extra GUIDE Reprieve Services requirements and details surrounding the payment for such services are specified in the Involvement Arrangement.

The facilities payment is intended for companies who desire to establish brand-new dementia care programs and require resources to get going. GUIDE Individuals certified as a safety net service provider based on the proportion of their patient 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 safeguard service provider, a new program applicant must have had a Medicare FFS beneficiary population made up of at least 36% beneficiaries getting the Part D low-income subsidy or 33.7% beneficiaries who are dually eligible for Medicare and Medicaid. Accepting the infrastructure payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE break services will go through recipient cost-sharing.

When an aligned recipient is re-assessed and designated to a new tier, the GUIDE Participant will be eligible to bill the G-code for the established client payment rate associated with that tier the following month. GUIDE Participants that withdraw or are ended before the start of the second efficiency year will be required to pay back the entire value of their infrastructure payment to CMS.

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After the second performance year, GUIDE Participants that withdraw or are ended from the GUIDE Design are not required to repay the facilities 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 Doctor Cost Schedule (PFS) services, consisting of chronic care management and principal 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 Participants will continue to expense under conventional Medicare fee-for-service for all services that are not included under the DCMP. CMS may include or eliminate codes over time to show changes in PFS billing codes.

The care group may consist of the beneficiary's primary care supplier, and if not, the care group is needed to recognize and share details with the beneficiary's main care provider and experts and outline the care coordination services needed to manage the recipient's dementia and co-occurring conditions. CMS will offer GUIDE Individuals data associated with the performance determines that CMS utilizes to identify the GUIDE Participant's performance-based change to the DCMP.GUIDE Participants in the established program track ought to be prepared to begin providing services under the GUIDE Model on July 1, 2024, and costs for those services throughout the Design Efficiency Duration.

Yes, GUIDE beneficiary and service provider overlap with the Shared Savings Program is allowed. The GUIDE Design is designed to be suitable with other CMS models and programs that aim to enhance care and decrease spending. CMS believes targeted support for people with dementia and their caretakers will assist enhance population-based care results in general.

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As an example, if an ACO is participating in both the GUIDE Model and the Shared Cost Savings Program throughout Efficiency Year 2024 and then renews and starts a brand-new contract duration 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 Standard Year 3. GUIDE Break Service claims will not be counted toward ACO expenses, shared cost savings, nor benchmarking beginning in 2024 for the period of the GUIDE Model.

GUIDE Participants might take part in multiple CMS Innovation Center designs or Medicare value-based care efforts to speed up innovation in care delivery, reduce the cost of care, and enhance population health. Individuals and recipients are qualified to participate in the GUIDE Design and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not consist of the Dementia Care Management Payment (DCMP) or Reprieve Service declares in the REACH ACOs' total expense of care expenses or calculation of shared savings/shared losses.

Overlapping participants ought to follow GUIDE billing assistance as set forth below. ACO REACH claim reductions will not apply to DCMP. ACO REACH will consist of DCMP expenses for purposes of positioning calculations. GUIDE Break Service claims will not count toward ACO expenditures, shared savings, or benchmarking in 2025 and for the duration of the GUIDE Design.

As of January 1, 2025, GUIDE Individuals likewise taking part in ACO REACH ought to cease billing the Medicare Doctor Charge Schedule Providers included under the DCMP (See Exhibition 5 in the GUIDE Payment Methodology Paper (PDF)). Participants getting involved in both models must follow the GUIDE billing requirements in the GUIDE Involvement Agreement and GUIDE Payment Approach Paper.

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The GUIDE Individual must not bill Medicare independently for the services offered in the extensive evaluation. The thorough 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 Individual can bill for a proper Medicare-covered professional service that corresponds to the services rendered.