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GUIDE Individuals have the option, and are not required, to make readily available respite through an adult day center or a 24-hour center. Extra GUIDE Break Services requirements and information surrounding the payment for such services are specified in the Involvement Contract.

The facilities payment is planned for suppliers who wish to establish new dementia care programs and need resources to get begun. GUIDE Individuals qualified as a safeguard supplier based on the percentage of their client population that is dually qualified for Medicare and Medicaid or get the Part D low-income aid.

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To qualify as a GUIDE safeguard provider, a brand-new program applicant need to have had a Medicare FFS beneficiary population consisted of a minimum of 36% recipients getting the Part D low-income aid or 33.7% recipients who are dually qualified for Medicare and Medicaid. Accepting the infrastructure payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE respite services will be subject to 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 recognized client payment rate connected with that tier the following month. GUIDE Participants that withdraw or are ended before the start of the 2nd efficiency year will be required to repay the entire value of their facilities payment to CMS.

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After the 2nd efficiency year, GUIDE Individuals that withdraw or are ended from the GUIDE Design are not needed to repay the infrastructure payment. The main design 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 Charge Set Up (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 design, so GUIDE Participants will continue to expense under conventional Medicare fee-for-service for all services that are not consisted of under the DCMP. Extra information, including a complete list of duplicative codes, is offered in the Ask for Applications (Table 8, pg. 35). CMS may include or get rid of codes with time to show changes in PFS billing codes.

The care team may consist of the beneficiary's medical care company, and if not, the care group is required to determine and share information with the beneficiary's medical care supplier and specialists and describe the care coordination services needed to manage the recipient's dementia and co-occurring conditions. CMS will supply GUIDE Participants information connected to the performance determines that CMS utilizes to determine the GUIDE Individual's performance-based adjustment to the DCMP.GUIDE Participants in the recognized program track ought to be prepared to begin furnishing services under the GUIDE Model on July 1, 2024, and bill for those services during the Model Performance Duration.

Yes, GUIDE recipient and supplier overlap with the Shared Savings Program is enabled. The GUIDE Model is created to be suitable with other CMS models and programs that intend to improve care and reduce spending. CMS believes targeted assistance for people with dementia and their caretakers will assist enhance population-based care outcomes overall.

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The Dementia Care Management Payment (DCMP), the per recipient monthly GUIDE payment, will be consisted of in 2024 Shared Savings Program expenditures. When 2024 becomes a benchmark year, DCMPs will be consisted of in Shared Savings Program criteria estimations. As an example, if an ACO is taking part in both the GUIDE Design and the Shared Savings Program during Efficiency Year 2024 and then restores and begins a new agreement period since January 1, 2025, that ACO would have their Shared Savings Program standard based on 2022, 2023 and 2024, and would have DCMPs counted in Criteria Year 3. However, GUIDE Respite Service claims will not be counted towards ACO expenses, shared savings, nor benchmarking beginning in 2024 for the duration of the GUIDE Model.

GUIDE Participants may take part in numerous CMS Innovation Center designs or Medicare value-based care initiatives to speed up development in care shipment, reduce the cost of care, and enhance population health. Individuals and recipients 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 cost of care expenditures or estimation of shared savings/shared losses.

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

As of January 1, 2025, GUIDE Individuals also taking part in ACO REACH must discontinue billing the Medicare Doctor Charge Arrange Providers included under the DCMP (See Display 5 in the GUIDE Payment Methodology Paper (PDF)). Participants getting involved in both designs need to follow the GUIDE billing requirements in the GUIDE Participation Agreement and GUIDE Payment Method Paper.

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The GUIDE Participant must not bill Medicare independently for the services supplied in the comprehensive assessment. The detailed assessment (and any re-assessments) is covered by the DCMP. If CMS identifies the beneficiary is not eligible for the GUIDE Model, the GUIDE Individual can bill for a suitable Medicare-covered professional service that corresponds to the services rendered.