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GUIDE Individuals have the option, and are not required, to make offered break 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 Involvement Arrangement.

The infrastructure payment is planned for service providers who want to develop brand-new dementia care programs and require resources to start. GUIDE Individuals certified as a safeguard service provider based upon the proportion of their patient population that is dually qualified for Medicare and Medicaid or receive the Part D low-income subsidy.

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To certify as a GUIDE safeguard provider, a new program applicant should have had a Medicare FFS recipient population comprised of at least 36% recipients receiving 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 break services will be subject to beneficiary cost-sharing.

When a lined up beneficiary is re-assessed and designated to a brand-new tier, the GUIDE Individual will be eligible 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 efficiency year will be required to repay the whole 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 required to pay back the infrastructure payment. The primary model 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 Schedule (PFS) services, consisting of chronic 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 design, so GUIDE Participants will continue to costs under standard Medicare fee-for-service for all services that are not included under the DCMP. Extra information, including a complete list of duplicative codes, is available in the Request for Applications (Table 8, pg. 35). CMS might add or get rid of codes with time to show changes in PFS billing codes.

The care team might include the recipient's main care supplier, and if not, the care team is needed to recognize and share info with the beneficiary's main care service provider and experts and describe the care coordination services required to manage the beneficiary's dementia and co-occurring conditions. CMS will offer GUIDE Participants information connected to the performance measures that CMS utilizes to determine the GUIDE Participant's performance-based adjustment to the DCMP.GUIDE Individuals in the established program track should be prepared to begin providing services under the GUIDE Design on July 1, 2024, and bill for those services throughout the Model Performance Duration.

Yes, GUIDE recipient and supplier overlap with the Shared Cost savings Program is permitted. The GUIDE Model is developed to be compatible with other CMS designs and programs that intend to enhance care and minimize spending. CMS believes targeted support for people with dementia and their caretakers will help improve population-based care results in general.

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As an example, if an ACO is taking part in both the GUIDE Model and the Shared Cost Savings Program during Performance Year 2024 and then renews and begins a new arrangement 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 Benchmark Year 3. GUIDE Break Service claims will not be counted toward ACO expenses, shared savings, nor benchmarking beginning in 2024 for the period of the GUIDE Model.

GUIDE Individuals may take part in numerous CMS Innovation Center models or Medicare value-based care initiatives to accelerate development in care delivery, decrease the expense of care, and enhance population health. Participants and beneficiaries 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 Break Service claims in the REACH ACOs' total expense of care expenses or calculation of shared savings/shared losses.

Overlapping participants should follow GUIDE billing assistance as set forth below. GUIDE Reprieve Service claims will not count toward ACO expenses, shared savings, or benchmarking in 2025 and for the period of the GUIDE Model.

As of January 1, 2025, GUIDE Individuals likewise getting involved in ACO REACH should cease billing the Medicare Physician Cost Schedule Providers consisted of under the DCMP (See Exhibition 5 in the GUIDE Payment Methodology Paper (PDF)). Participants taking part in both models should follow the GUIDE billing requirements in the GUIDE Participation Arrangement and GUIDE Payment Approach Paper.

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The GUIDE Participant must not bill Medicare individually for the services supplied in the detailed assessment. The extensive assessment (and any re-assessments) is covered by the DCMP. If CMS figures out the beneficiary is not qualified for the GUIDE Design, the GUIDE Individual can bill for an appropriate Medicare-covered professional service that represents the services rendered.