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GUIDE Participants have the option, and are not needed, 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 specified in the Involvement Arrangement. GUIDE Participants in the brand-new program track that are classified as safety net suppliers will be qualified to receive a one-time facilities payment of $75,000 (geographically adjusted by the Geographic Change Aspect [GAF] to cover some of the upfront costs of establishing a new dementia care program.

The infrastructure payment is meant for providers who desire to develop new dementia care programs and need resources to get begun. GUIDE Participants certified as a safety net provider based upon 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 certify as a GUIDE safeguard provider, a new program candidate must have had a Medicare FFS beneficiary population consisted of at least 36% beneficiaries getting the Part D low-income subsidy or 33.7% beneficiaries who are dually eligible for Medicare and Medicaid. Accepting the facilities payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE respite services will be subject to beneficiary cost-sharing.

When an aligned recipient 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 related to that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the 2nd efficiency year will be required to pay back the entire value of their facilities 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 required to repay 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 Charge Arrange (PFS) services, consisting of persistent 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 model, so GUIDE Individuals will continue to bill under conventional Medicare fee-for-service for all services that are not included under the DCMP. Extra details, including a total list of duplicative codes, is readily available in the Demand for Applications (Table 8, pg. 35). CMS might include or remove codes in time to reflect modifications in PFS billing codes.

The care group may consist of the beneficiary's main care provider, and if not, the care group is required to recognize and share information with the recipient's primary care supplier and experts and outline the care coordination services needed to manage the recipient's dementia and co-occurring conditions. CMS will supply GUIDE Individuals information associated with the performance measures that CMS uses to identify the GUIDE Individual's performance-based adjustment to the DCMP.GUIDE Participants in the established program track must be prepared to begin providing services under the GUIDE Design on July 1, 2024, and expense for those services throughout the Design Performance Period.

Yes, GUIDE beneficiary and supplier overlap with the Shared Savings Program is allowed. The GUIDE Model is created to be compatible with other CMS designs and programs that aim to improve care and reduce costs. CMS believes targeted assistance for individuals with dementia and their caregivers will assist improve population-based care outcomes overall.

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The Dementia Care Management Payment (DCMP), the per recipient per month GUIDE payment, will be consisted of in 2024 Shared Cost savings Program expenses. When 2024 becomes a benchmark year, DCMPs will be consisted of in Shared Cost savings Program criteria calculations. As an example, if an ACO is taking part in both the GUIDE Model and the Shared Cost Savings Program during Efficiency Year 2024 and after that restores and starts a new contract period as of January 1, 2025, that ACO would have their Shared Cost savings Program benchmark based on 2022, 2023 and 2024, and would have DCMPs counted in Benchmark Year 3. Nevertheless, GUIDE Break Service claims will not be counted toward ACO expenditures, shared cost savings, nor benchmarking beginning in 2024 throughout of the GUIDE Model.

GUIDE Individuals might take part in multiple CMS Development Center designs or Medicare value-based care initiatives to accelerate innovation in care delivery, lower the expense of care, and improve population health. Participants and beneficiaries are qualified to participate in the GUIDE Model and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not include the Dementia Care Management Payment (DCMP) or Reprieve Service claims in the REACH ACOs' overall expense of care expenses or calculation of shared savings/shared losses.

Overlapping individuals must follow GUIDE billing guidance as set forth below. GUIDE Respite Service claims will not count toward ACO expenses, shared savings, or benchmarking in 2025 and for the duration of the GUIDE Model.

As of January 1, 2025, GUIDE Participants likewise taking part in ACO REACH should cease billing the Medicare Doctor Fee Arrange Providers consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Approach Paper (PDF)). Participants taking part in both designs should follow the GUIDE billing requirements in the GUIDE Participation Arrangement and GUIDE Payment Method Paper.

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The GUIDE Individual should not bill Medicare separately for the services provided in the thorough evaluation. The extensive assessment (and any re-assessments) is covered by the DCMP. If CMS figures out the beneficiary is not eligible for the GUIDE Model, the GUIDE Individual can bill for a suitable Medicare-covered professional service that represents the services rendered.