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GUIDE Individuals have the choice, and are not required, to make offered reprieve through an adult day center or a 24-hour facility. Additional GUIDE Break Solutions requirements and information surrounding the payment for such services are defined in the Involvement Contract.

The facilities payment is intended for companies who wish to establish brand-new dementia care programs and require resources to get going. GUIDE Participants qualified as a safeguard provider based on the proportion of their patient population that is dually eligible for Medicare and Medicaid or receive the Part D low-income aid.

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To certify as a GUIDE safeguard supplier, a new program applicant must have had a Medicare FFS beneficiary population comprised of a minimum of 36% recipients receiving the Part D low-income subsidy 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 reprieve services will be subject to recipient cost-sharing.

When a lined up beneficiary is re-assessed and appointed to a new tier, the GUIDE Participant will be qualified 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 2nd efficiency year will be needed to pay back the whole value of their facilities payment to CMS.

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After the second performance year, GUIDE Individuals that withdraw or are ended from the GUIDE Model are not required to pay back the facilities payment. The primary model 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 Physician Cost Arrange (PFS) services, including persistent 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 Individuals will continue to bill under traditional Medicare fee-for-service for all services that are not consisted of under the DCMP. Extra information, consisting of a complete list of duplicative codes, is available in the Demand for Applications (Table 8, pg. 35). CMS might include or eliminate codes gradually to reflect changes in PFS billing codes.

The care group may include the recipient's medical care supplier, and if not, the care group is needed to determine and share info with the beneficiary's main care service provider and experts and describe the care coordination services required to handle the recipient's dementia and co-occurring conditions. CMS will provide GUIDE Individuals information connected to the performance determines that CMS uses to figure out the GUIDE Participant's performance-based modification to the DCMP.GUIDE Individuals in the established program track ought to be prepared to begin providing services under the GUIDE Model on July 1, 2024, and expense for those services during the Design Efficiency Duration.

Yes, GUIDE recipient and provider overlap with the Shared Savings Program is allowed. The GUIDE Model is created to be compatible with other CMS models and programs that aim to improve care and lower spending. CMS believes targeted assistance for individuals with dementia and their caretakers will help enhance population-based care results in general.

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The Dementia Care Management Payment (DCMP), the per beneficiary each month GUIDE payment, will be included in 2024 Shared Cost savings Program expenses. When 2024 becomes a benchmark year, DCMPs will be included in Shared Cost savings Program standard calculations. As an example, if an ACO is getting involved in both the GUIDE Design and the Shared Savings Program during Efficiency Year 2024 and after that restores and starts a new contract duration as of January 1, 2025, that ACO would have their Shared Savings Program benchmark based upon 2022, 2023 and 2024, and would have DCMPs counted in Criteria Year 3. Nevertheless, GUIDE Reprieve Service claims will not be counted toward ACO expenditures, shared cost savings, nor benchmarking beginning in 2024 for the period of the GUIDE Design.

GUIDE Individuals may take part in numerous CMS Innovation Center models or Medicare value-based care initiatives to accelerate development in care shipment, reduce the cost of care, and improve population health. Participants and recipients are qualified to take part in the GUIDE Model and the ACO REACH Model. For the rest of CY 2024, ACO REACH will not consist of the Dementia Care Management Payment (DCMP) or Respite Service declares in the REACH ACOs' overall expense of care expenses or calculation of shared savings/shared losses.

Overlapping individuals should follow GUIDE billing assistance as stated below. ACO REACH claim decreases will not apply to DCMP. ACO REACH will consist of DCMP expenses for functions of alignment computations. GUIDE Reprieve Service claims will not count towards ACO expenditures, shared cost savings, or benchmarking in 2025 and for the period of the GUIDE Design.

As of January 1, 2025, GUIDE Individuals also taking part in ACO REACH should stop billing the Medicare Physician Charge Arrange Services included under the DCMP (See Exhibit 5 in the GUIDE Payment Methodology Paper (PDF)). Participants taking part in both models should follow the GUIDE billing requirements in the GUIDE Involvement Arrangement and GUIDE Payment Method Paper.

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The GUIDE Individual need to not bill Medicare individually for the services supplied in the detailed assessment. The comprehensive evaluation (and any re-assessments) is covered by the DCMP. If CMS figures out the beneficiary is not eligible for the GUIDE Design, the GUIDE Participant can bill for a proper Medicare-covered professional service that corresponds to the services rendered.