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GUIDE Participants have the option, and are not required, to make readily available respite through an adult day center or a 24-hour facility. Extra GUIDE Break Solutions requirements and details surrounding the payment for such services are specified in the Participation Agreement.

The facilities payment is intended for providers who wish to develop brand-new dementia care programs and need resources to get going. GUIDE Participants certified as a safeguard service provider based on the percentage 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 qualify as a GUIDE safeguard provider, a brand-new program candidate should have had a Medicare FFS beneficiary population consisted of a minimum of 36% recipients receiving the Part D low-income aid or 33.7% recipients who are dually eligible for Medicare and Medicaid. Accepting the infrastructure payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE respite services will undergo recipient cost-sharing.

When a lined up beneficiary is re-assessed and appointed to a new tier, the GUIDE Individual will be eligible to bill the G-code for the established patient 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 required to repay 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 needed to pay back 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 replace fee-for-service payment for some existing Medicare Physician Cost Schedule (PFS) services, including chronic care management and principal 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 design, so GUIDE Individuals will continue to expense under standard Medicare fee-for-service for all services that are not included under the DCMP. Extra info, consisting of a complete list of duplicative codes, is offered in the Ask for Applications (Table 8, pg. 35). CMS may add or remove codes gradually to reflect modifications in PFS billing codes.

The care group might include the beneficiary's primary care service provider, and if not, the care group is needed to determine and share info with the beneficiary's medical care service provider and experts and detail the care coordination services needed to manage the beneficiary's dementia and co-occurring conditions. CMS will offer GUIDE Individuals information related to the performance determines that CMS utilizes to figure out the GUIDE Participant's performance-based modification to the DCMP.GUIDE Individuals in the established program track must be prepared to start furnishing services under the GUIDE Design on July 1, 2024, and bill for those services during the Model Efficiency Duration.

Yes, GUIDE recipient and provider overlap with the Shared Savings Program is permitted. The GUIDE Model is developed to be compatible with other CMS models and programs that intend to improve care and minimize spending. CMS believes targeted assistance for people with dementia and their caretakers will help improve population-based care results overall.

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As an example, if an ACO is taking part in both the GUIDE Model and the Shared Savings Program during Performance Year 2024 and then restores and begins a brand-new contract duration as of January 1, 2025, that ACO would have their Shared Cost savings Program criteria based on 2022, 2023 and 2024, and would have DCMPs counted in Criteria Year 3. GUIDE Reprieve Service claims will not be counted towards ACO expenditures, shared cost savings, nor benchmarking beginning in 2024 for the duration of the GUIDE Design.

GUIDE Individuals might take part in several CMS Innovation Center designs or Medicare value-based care initiatives to speed up development in care shipment, reduce the expense of care, and enhance population health. Individuals and beneficiaries are eligible to participate 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 Reprieve Service declares in the REACH ACOs' overall expense of care expenditures or estimation of shared savings/shared losses.

Overlapping participants should follow GUIDE billing assistance as set forth listed below. GUIDE Reprieve 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 stop billing the Medicare Doctor Cost Schedule Providers consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Method Paper (PDF)). Participants taking part in both designs should follow the GUIDE billing requirements in the GUIDE Participation Contract and GUIDE Payment Approach Paper.

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The GUIDE Individual should not bill Medicare separately for the services provided in the thorough evaluation. The thorough evaluation (and any re-assessments) is covered by the DCMP. If CMS identifies the recipient is not eligible for the GUIDE Model, the GUIDE Individual can bill for an appropriate Medicare-covered expert service that corresponds to the services rendered.