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GUIDE Participants have the choice, and are not required, to make offered break through an adult day center or a 24-hour facility. Additional GUIDE Break Providers requirements and information surrounding the payment for such services are specified in the Participation Arrangement.

The facilities payment is intended for providers who desire to establish brand-new dementia care programs and need resources to get going. GUIDE Participants qualified as a safeguard provider based upon the proportion of their client population that is dually eligible for Medicare and Medicaid or receive the Part D low-income subsidy.

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To certify as a GUIDE safeguard service provider, a brand-new program candidate must have had a Medicare FFS recipient population consisted of at least 36% recipients receiving the Part D low-income aid 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 respite services will undergo beneficiary cost-sharing.

When a lined up beneficiary is re-assessed and designated to a brand-new tier, the GUIDE Participant will be eligible to bill the G-code for the established patient payment rate related to 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 infrastructure payment to CMS.

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After the second efficiency year, GUIDE Individuals that withdraw or are terminated from the GUIDE Design are not required to pay back the facilities payment. The main 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 Set Up (PFS) services, consisting of 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 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 reflect modifications in PFS billing codes.

The care team may consist of the recipient's primary care company, and if not, the care group is required to determine and share info with the recipient's medical care provider and experts and outline the care coordination services needed to handle the beneficiary's dementia and co-occurring conditions. CMS will supply GUIDE Participants data associated with the efficiency determines that CMS uses to identify the GUIDE Individual's performance-based adjustment to the DCMP.GUIDE Individuals in the established program track must be prepared to start furnishing services under the GUIDE Model on July 1, 2024, and costs for those services throughout the Model Performance Period.

Yes, GUIDE recipient and company overlap with the Shared Savings Program is allowed. The GUIDE Model is designed to be compatible with other CMS designs and programs that aim to improve care and reduce spending. CMS believes targeted assistance for people with dementia and their caregivers will help enhance population-based care outcomes overall.

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The Dementia Care Management Payment (DCMP), the per beneficiary per month GUIDE payment, will be included in 2024 Shared Cost savings Program expenditures. When 2024 becomes a benchmark year, DCMPs will be included in Shared Savings Program criteria calculations. As an example, if an ACO is taking part in both the GUIDE Design and the Shared Savings Program throughout Performance Year 2024 and after that renews and starts a new arrangement period since January 1, 2025, that ACO would have their Shared Savings Program benchmark based on 2022, 2023 and 2024, and would have DCMPs counted in Standard Year 3. GUIDE Reprieve Service claims will not be counted toward ACO expenses, shared cost savings, nor benchmarking start in 2024 for the duration of the GUIDE Model.

GUIDE Individuals might take part in numerous CMS Innovation Center models or Medicare value-based care initiatives to accelerate innovation in care delivery, reduce the expense of care, and enhance population health. Individuals and recipients are eligible to take part in the GUIDE Design and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not consist of the Dementia Care Management Payment (DCMP) or Reprieve Service claims in the REACH ACOs' overall cost of care expenses or estimation of shared savings/shared losses.

Overlapping participants need to follow GUIDE billing guidance as set forth listed below. GUIDE Break Service claims will not count toward ACO expenses, shared cost savings, or benchmarking in 2025 and for the period of the GUIDE Design.

As of January 1, 2025, GUIDE Individuals likewise taking part in ACO REACH must discontinue billing the Medicare Physician Cost Set up Solutions consisted of under the DCMP (See Display 5 in the GUIDE Payment Method Paper (PDF)). Participants taking part in both models should follow the GUIDE billing requirements in the GUIDE Involvement Arrangement and GUIDE Payment Approach Paper.

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The GUIDE Participant should not bill Medicare individually for the services offered in the detailed evaluation. The thorough assessment (and any re-assessments) is covered by the DCMP. If CMS determines the recipient is not eligible for the GUIDE Design, the GUIDE Participant can bill for an appropriate Medicare-covered expert service that corresponds to the services rendered.