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GUIDE Individuals have the alternative, and are not required, to make available reprieve 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 Participation Agreement. GUIDE Individuals in the new program track that are categorized as safeguard suppliers will be eligible to get a one-time facilities payment of $75,000 (geographically adjusted by the Geographic Change Aspect [GAF] to cover some of the upfront expenses of developing a brand-new dementia care program.

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

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To qualify as a GUIDE safeguard supplier, a new program candidate should have had a Medicare FFS beneficiary population comprised of a minimum of 36% recipients receiving the Part D low-income subsidy or 33.7% beneficiaries who are dually qualified for Medicare and Medicaid. Accepting the facilities payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE break services will be subject to recipient cost-sharing.

When a lined up recipient is re-assessed and assigned to a brand-new tier, the GUIDE Individual will be qualified to bill the G-code for the established client payment rate connected with that tier the following month. GUIDE Individuals that withdraw or are terminated before the start of the 2nd efficiency year will be needed to pay back the entire worth of their infrastructure payment to CMS.

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After the 2nd efficiency year, GUIDE Participants that withdraw or are ended from the GUIDE Model are not required to pay back the facilities payment. The main 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 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 planning, 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 costs under traditional Medicare fee-for-service for all services that are not consisted of under the DCMP. Extra info, including a complete list of duplicative codes, is available in the Request for Applications (Table 8, pg. 35). CMS may add or eliminate codes over time to reflect changes in PFS billing codes.

The care group might consist of the beneficiary's primary care supplier, and if not, the care group is needed to determine and share information with the recipient's medical care provider and professionals and outline the care coordination services required to handle the beneficiary's dementia and co-occurring conditions. CMS will supply GUIDE Participants data associated with the performance measures that CMS utilizes to identify the GUIDE Participant's performance-based modification to the DCMP.GUIDE Participants in the established program track must be prepared to begin furnishing services under the GUIDE Design on July 1, 2024, and bill for those services during the Model Performance Duration.

Yes, GUIDE beneficiary and supplier overlap with the Shared Cost savings Program is allowed. The GUIDE Model is designed to be suitable with other CMS designs and programs that aim to improve care and minimize spending. CMS thinks targeted assistance for people with dementia and their caregivers will help enhance population-based care results in general.

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As an example, if an ACO is taking part in both the GUIDE Model 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 Benchmark Year 3. GUIDE Break Service claims will not be counted towards ACO expenses, shared cost savings, nor benchmarking start in 2024 for the duration of the GUIDE Design.

GUIDE Participants might take part in multiple CMS Innovation Center models or Medicare value-based care efforts to speed up innovation in care delivery, decrease the expense of care, and enhance population health. Participants and beneficiaries are eligible to take part in the GUIDE Design and the ACO REACH Model. For the rest of CY 2024, ACO REACH will not consist of the Dementia Care Management Payment (DCMP) or Break Service declares in the REACH ACOs' overall expense of care expenditures or estimation of shared savings/shared losses.

Overlapping participants ought to follow GUIDE billing guidance as stated listed below. ACO REACH claim decreases will not apply to DCMP. ACO REACH will include DCMP expenses for functions of alignment calculations. 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 Individuals also taking part in ACO REACH ought to stop billing the Medicare Doctor Fee Set up Providers consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Method Paper (PDF)). Participants taking part in both designs need to follow the GUIDE billing requirements in the GUIDE Involvement Arrangement and GUIDE Payment Methodology Paper.

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The GUIDE Participant must not bill Medicare separately for the services supplied in the detailed assessment. The comprehensive evaluation (and any re-assessments) is covered by the DCMP. If CMS determines the beneficiary is not qualified for the GUIDE Model, the GUIDE Individual can bill for a suitable Medicare-covered expert service that represents the services rendered.