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GUIDE Individuals have the option, and are not required, to make offered reprieve through an adult day center or a 24-hour facility. Additional GUIDE Respite Providers requirements and information surrounding the payment for such services are defined in the Participation Agreement.

The infrastructure payment is meant for suppliers who wish to establish brand-new dementia care programs and need resources to start. GUIDE Participants certified as a safety net supplier based upon the percentage 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 brand-new program candidate need to have had a Medicare FFS beneficiary population comprised of a minimum of 36% recipients receiving the Part D low-income aid or 33.7% recipients who are dually qualified for Medicare and Medicaid. Accepting the facilities payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE reprieve services will go through recipient cost-sharing.

When an aligned beneficiary is re-assessed and appointed to a 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 ended before the start of the second performance year will be needed to repay the entire value of their facilities payment to CMS.

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After the 2nd performance year, GUIDE Participants that withdraw or are ended from the GUIDE Model are not needed to repay the infrastructure payment. The primary 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 change fee-for-service payment for some existing Medicare Doctor Cost Set Up (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 Design is not a total-cost-of-care model, so GUIDE Participants will continue to bill under standard Medicare fee-for-service for all services that are not included under the DCMP. CMS might include or get rid of codes over time to show changes in PFS billing codes.

The care team might include the recipient's medical care provider, and if not, the care group is required to identify and share details with the recipient's main care company and professionals and describe the care coordination services required to handle the beneficiary's dementia and co-occurring conditions. CMS will offer GUIDE Individuals data associated with the efficiency determines that CMS utilizes to figure out the GUIDE Individual's performance-based modification to the DCMP.GUIDE Individuals in the established program track should be prepared to start furnishing services under the GUIDE Design on July 1, 2024, and costs for those services during the Design Performance Duration.

Yes, GUIDE beneficiary and provider overlap with the Shared Cost savings Program is enabled. The GUIDE Design is designed to be compatible with other CMS designs and programs that aim to improve care and reduce spending. CMS thinks targeted assistance for individuals with dementia and their caregivers will assist enhance population-based care outcomes in general.

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As an example, if an ACO is taking part in both the GUIDE Design and the Shared Cost Savings Program throughout Efficiency Year 2024 and then renews and starts a brand-new arrangement 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 Break Service claims will not be counted toward ACO expenditures, shared cost savings, nor benchmarking start in 2024 for the period of the GUIDE Design.

GUIDE Participants might get involved in multiple CMS Development Center models or Medicare value-based care efforts to accelerate development in care delivery, reduce the cost of care, and improve population health. Participants and beneficiaries are qualified to take part in the GUIDE Design 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' overall expense of care expenses or calculation of shared savings/shared losses.

Overlapping participants must follow GUIDE billing assistance as set forth listed below. ACO REACH claim decreases will not apply to DCMP. ACO REACH will consist of DCMP expenses for functions of positioning calculations. GUIDE Respite Service claims will not count towards ACO expenses, shared savings, or benchmarking in 2025 and for the duration of the GUIDE Model.

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

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The GUIDE Participant should not bill Medicare independently for the services offered in the extensive assessment. The thorough assessment (and any re-assessments) is covered by the DCMP. If CMS identifies the beneficiary is not eligible for the GUIDE Model, the GUIDE Participant can bill for a proper Medicare-covered professional service that represents the services rendered.