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However, GUIDE Participants have the alternative, and are not required, to make readily available break through an adult day center or a 24-hour center. Additional GUIDE Respite Providers requirements and information surrounding the payment for such services are specified in the Involvement Contract. GUIDE Participants in the new program track that are classified as security net suppliers will be qualified to get a one-time infrastructure payment of $75,000 (geographically changed by the Geographic Modification Factor [GAF] to cover a few of the in advance expenses of developing a new dementia care program.

The infrastructure payment is intended for service providers who desire to develop new dementia care programs and need resources to get going. GUIDE Individuals qualified as a security net company based on the proportion of their client population that is dually eligible for Medicare and Medicaid or receive the Part D low-income aid.

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To certify as a GUIDE safeguard company, a brand-new program candidate need to have had a Medicare FFS recipient population consisted of a minimum of 36% beneficiaries getting the Part D low-income aid or 33.7% beneficiaries who are dually eligible for Medicare and Medicaid. Accepting the infrastructure payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE break services will go through beneficiary cost-sharing.

When a lined up beneficiary is re-assessed and appointed to a brand-new tier, the GUIDE Individual will be qualified to bill the G-code for the established client payment rate associated with that tier the following month. GUIDE Individuals that withdraw or are ended before the start of the 2nd performance year will be required to repay the entire value of their infrastructure payment to CMS.

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After the second efficiency year, GUIDE Participants that withdraw or are ended from the GUIDE Design are not needed 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 replace fee-for-service payment for some existing Medicare Physician Charge Arrange (PFS) services, including 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 traditional Medicare fee-for-service for all services that are not included under the DCMP. Extra info, including a complete list of duplicative codes, is readily available in the Demand for Applications (Table 8, pg. 35). CMS might add or remove codes over time to reflect modifications in PFS billing codes.

The care group may consist of the recipient's medical care company, and if not, the care team is needed to identify and share info with the recipient's medical care service provider and professionals and lay out the care coordination services needed to manage the recipient's dementia and co-occurring conditions. CMS will offer GUIDE Individuals data associated with the efficiency determines that CMS uses to determine the GUIDE Participant's performance-based change to the DCMP.GUIDE Individuals in the established program track ought to be prepared to begin providing services under the GUIDE Model on July 1, 2024, and bill for those services during the Model Performance Period.

Yes, GUIDE beneficiary and supplier overlap with the Shared Savings Program is permitted. The GUIDE Design is designed to be suitable with other CMS designs and programs that intend to improve care and minimize spending. CMS believes targeted support for people with dementia and their caretakers will assist enhance population-based care results overall.

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As an example, if an ACO is participating in both the GUIDE Model and the Shared Cost Savings Program throughout Performance Year 2024 and then restores and starts a new contract duration 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 Standard Year 3. GUIDE Reprieve Service claims will not be counted toward ACO expenses, shared savings, nor benchmarking beginning in 2024 for the duration of the GUIDE Design.

GUIDE Individuals may take part in several CMS Development Center models or Medicare value-based care initiatives to speed up development in care delivery, decrease the expense of care, and enhance population health. Individuals and recipients are qualified to take part 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 Respite Service claims in the REACH ACOs' total expense of care expenditures or estimation of shared savings/shared losses.

Overlapping participants must follow GUIDE billing assistance as set forth listed below. ACO REACH claim reductions will not apply to DCMP. ACO REACH will include DCMP expenditures for purposes of positioning calculations. Nevertheless, GUIDE Reprieve Service claims will not count toward ACO expenses, shared cost savings, or benchmarking in 2025 and for the duration of the GUIDE Design.

As of January 1, 2025, GUIDE Individuals also taking part in ACO REACH should discontinue billing the Medicare Physician Charge Set up Solutions included under the DCMP (See Exhibit 5 in the GUIDE Payment Method Paper (PDF)). Participants taking part in both models must follow the GUIDE billing requirements in the GUIDE Involvement Contract 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 assessment. The detailed evaluation (and any re-assessments) is covered by the DCMP. If CMS identifies the recipient is not qualified for the GUIDE Design, the GUIDE Individual can bill for a proper Medicare-covered expert service that corresponds to the services rendered.