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However, GUIDE Participants have the choice, and are not required, to make available respite through an adult day center or a 24-hour facility. Extra GUIDE Respite Providers requirements and details surrounding the payment for such services are specified in the Participation Contract. GUIDE Individuals in the brand-new program track that are classified as safeguard companies will be eligible to get a one-time infrastructure payment of $75,000 (geographically changed by the Geographic Change Aspect [GAF] to cover a few of the upfront expenses of establishing a brand-new dementia care program.

The infrastructure payment is meant for suppliers who wish to establish new dementia care programs and require resources to start. GUIDE Participants certified as a safety net company based on the proportion of their patient population that is dually qualified for Medicare and Medicaid or receive the Part D low-income aid.

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To certify as a GUIDE safeguard service provider, a brand-new program applicant should have had a Medicare FFS beneficiary population comprised of a minimum of 36% recipients receiving the Part D low-income subsidy or 33.7% recipients who are dually eligible for Medicare and Medicaid. Accepting the infrastructure payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE respite services will undergo beneficiary cost-sharing.

When an aligned beneficiary is re-assessed and appointed to a new tier, the GUIDE Individual will be qualified to bill the G-code for the recognized client payment rate associated with 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 infrastructure payment to CMS.

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After the second performance year, GUIDE Individuals that withdraw or are ended from the GUIDE Design are not needed to pay back the facilities payment. The primary 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 replace fee-for-service payment for some existing Medicare Doctor Cost 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 Individuals will continue to bill under conventional Medicare fee-for-service for all services that are not consisted of under the DCMP. Additional info, consisting of a total list of duplicative codes, is readily available in the Ask for Applications (Table 8, pg. 35). CMS may add or remove codes in time to show changes in PFS billing codes.

The care group may consist of the beneficiary's medical care provider, and if not, the care team is required to determine and share information with the recipient's medical care service provider and experts and outline the care coordination services required to handle the recipient's dementia and co-occurring conditions. CMS will offer GUIDE Individuals information connected to the efficiency measures that CMS utilizes to figure out the GUIDE Participant's performance-based change to the DCMP.GUIDE Participants in the recognized program track need to be prepared to begin furnishing services under the GUIDE Model on July 1, 2024, and expense for those services during the Design Performance Duration.

Yes, GUIDE recipient and supplier overlap with the Shared Savings Program is enabled. The GUIDE Design is designed to be suitable with other CMS models and programs that aim to improve care and minimize spending. CMS believes targeted assistance for people with dementia and their caretakers will help improve 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 Savings Program during Performance Year 2024 and then restores and begins a new contract period 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 Criteria Year 3. GUIDE Reprieve Service claims will not be counted toward ACO expenses, shared savings, nor benchmarking beginning in 2024 for the period of the GUIDE Design.

GUIDE Participants may participate in multiple CMS Innovation Center models or Medicare value-based care efforts to accelerate innovation in care shipment, reduce the expense of care, and improve population health. Participants and recipients are eligible to participate in the GUIDE Design and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not include the Dementia Care Management Payment (DCMP) or Break Service declares in the REACH ACOs' overall cost of care expenses or computation of shared savings/shared losses.

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

Since January 1, 2025, GUIDE Participants likewise taking part in ACO REACH should cease billing the Medicare Physician Fee Set up Services included under the DCMP (See Exhibition 5 in the GUIDE Payment Approach Paper (PDF)). Participants participating in both models should follow the GUIDE billing requirements in the GUIDE Involvement Agreement and GUIDE Payment Method Paper.

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