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However, GUIDE Participants have the choice, and are not required, to offer break through an adult day center or a 24-hour facility. Extra GUIDE Break Solutions requirements and information surrounding the payment for such services are defined in the Participation Arrangement. GUIDE Individuals in the new program track that are classified as safeguard suppliers will be eligible to receive a one-time facilities payment of $75,000 (geographically changed by the Geographic Adjustment Aspect [GAF] to cover a few of the in advance costs of establishing a brand-new dementia care program.

The infrastructure payment is meant for companies who wish to develop new dementia care programs and require resources to start. GUIDE Individuals qualified as a safeguard supplier based upon the percentage of their client population that is dually eligible for Medicare and Medicaid or get the Part D low-income subsidy.

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To certify as a GUIDE safety internet provider, a brand-new program applicant should have had a Medicare FFS recipient population consisted of at least 36% beneficiaries getting 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 break services will go through beneficiary cost-sharing.

When a lined up recipient is re-assessed and designated to a new tier, the GUIDE Individual will be eligible to bill the G-code for the recognized patient payment rate associated with that tier the following month. GUIDE Participants 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 terminated from the GUIDE Design are not needed to pay back the facilities payment. The main design 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, 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 Participants will continue to expense under traditional Medicare fee-for-service for all services that are not consisted of under the DCMP. CMS might include or get rid of codes over time to show changes in PFS billing codes.

The care group might consist of the beneficiary's medical care company, and if not, the care team is needed to recognize and share details with the beneficiary's primary care company and professionals and lay out the care coordination services required to handle 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 adjustment to the DCMP.GUIDE Individuals in the recognized program track should be prepared to start furnishing services under the GUIDE Model on July 1, 2024, and bill for those services during the Model Performance Duration.

Yes, GUIDE recipient and provider overlap with the Shared Cost savings Program is allowed. The GUIDE Design is created to be suitable with other CMS models and programs that intend to improve care and lower spending. CMS believes targeted assistance for individuals with dementia and their caregivers will assist enhance population-based care outcomes in general.

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The Dementia Care Management Payment (DCMP), the per recipient each month GUIDE payment, will be included in 2024 Shared Savings Program expenditures. When 2024 becomes a benchmark year, DCMPs will be included in Shared Savings Program criteria computations. As an example, if an ACO is taking part in both the GUIDE Design and the Shared Savings Program throughout Performance Year 2024 and then renews and begins a new contract period as of January 1, 2025, that ACO would have their Shared Savings Program criteria based on 2022, 2023 and 2024, and would have DCMPs counted in Benchmark Year 3. Nevertheless, GUIDE Respite 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 numerous CMS Development Center models or Medicare value-based care efforts to accelerate innovation in care delivery, 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 include the Dementia Care Management Payment (DCMP) or Break Service claims in the REACH ACOs' overall cost of care expenses or calculation of shared savings/shared losses.

Overlapping participants should follow GUIDE billing assistance as stated below. ACO REACH claim decreases will not apply to DCMP. ACO REACH will include DCMP expenditures for purposes of alignment estimations. GUIDE Break Service claims will not count towards ACO expenditures, shared cost 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 Physician Charge Arrange Solutions included under the DCMP (See Exhibit 5 in the GUIDE Payment Methodology Paper (PDF)). Participants taking part in both designs should follow the GUIDE billing requirements in the GUIDE Participation Agreement and GUIDE Payment Method Paper.

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The GUIDE Participant need to not bill Medicare independently for the services offered in the comprehensive evaluation. The comprehensive evaluation (and any re-assessments) is covered by the DCMP. If CMS identifies the beneficiary is not qualified for the GUIDE Model, the GUIDE Participant can bill for a suitable Medicare-covered expert service that represents the services rendered.