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However, GUIDE Participants have the option, and are not required, to make offered respite through an adult day center or a 24-hour facility. Additional GUIDE Respite Services requirements and information surrounding the payment for such services are specified in the Involvement Agreement. GUIDE Participants in the new program track that are classified as security net suppliers will be qualified to get a one-time facilities payment of $75,000 (geographically changed by the Geographic Modification Aspect [GAF] to cover a few of the upfront expenses of establishing a new dementia care program.

The facilities payment is intended for providers who desire to develop new dementia care programs and require resources to start. GUIDE Individuals qualified as a safeguard service provider based upon the percentage of their client 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 security web provider, a brand-new program candidate should have had a Medicare FFS beneficiary population made up 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 reprieve services will be subject to beneficiary cost-sharing.

When an aligned beneficiary is re-assessed and designated to a brand-new tier, the GUIDE Participant will be eligible to bill the G-code for the recognized patient payment rate related to that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the 2nd performance year will be needed to repay the whole worth of their infrastructure payment to CMS.

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After the second performance year, GUIDE Individuals that withdraw or are terminated from the GUIDE Design are not needed to repay the facilities 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 Cost Schedule (PFS) services, consisting of persistent care management and primary 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 Individuals will continue to costs under traditional Medicare fee-for-service for all services that are not consisted of under the DCMP. Extra info, including a total list of duplicative codes, is readily available in the Demand for Applications (Table 8, pg. 35). CMS may include or remove codes over time to reflect modifications in PFS billing codes.

The care team may consist of the recipient's primary care supplier, and if not, the care team is needed to determine and share information with the beneficiary's medical care company and specialists and describe the care coordination services required to manage the recipient's dementia and co-occurring conditions. CMS will supply GUIDE Participants information related to the performance measures that CMS uses to determine the GUIDE Participant's performance-based modification 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 costs for those services during the Model Efficiency Period.

Yes, GUIDE beneficiary and service provider overlap with the Shared Cost savings Program is enabled. The GUIDE Model is designed to be compatible with other CMS models and programs that intend to enhance care and reduce costs. CMS thinks targeted assistance for individuals with dementia and their caretakers will help enhance population-based care results overall.

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The Dementia Care Management Payment (DCMP), the per recipient each month GUIDE payment, will be consisted of in 2024 Shared Cost savings Program expenditures. When 2024 becomes a benchmark year, DCMPs will be included in Shared Savings Program benchmark calculations. As an example, if an ACO is getting involved in both the GUIDE Design and the Shared Cost Savings Program throughout Performance Year 2024 and after that restores and begins a brand-new agreement 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 Benchmark Year 3. However, GUIDE Respite Service claims will not be counted towards ACO expenses, shared savings, nor benchmarking start in 2024 for the period of the GUIDE Model.

GUIDE Participants might take part in several CMS Innovation Center models or Medicare value-based care initiatives to accelerate innovation in care delivery, minimize the expense of care, and enhance population health. Individuals and recipients are qualified to get involved in the GUIDE Model and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not consist of the Dementia Care Management Payment (DCMP) or Respite Service claims in the REACH ACOs' overall cost of care expenses or estimation 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 cost savings, or benchmarking in 2025 and for the period of the GUIDE Design.

Since January 1, 2025, GUIDE Participants also taking part in ACO REACH ought to discontinue billing the Medicare Physician Charge Arrange Solutions included under the DCMP (See Exhibition 5 in the GUIDE Payment Approach Paper (PDF)). Participants participating in both designs need to follow the GUIDE billing requirements in the GUIDE Involvement Contract and GUIDE Payment Methodology Paper.

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The GUIDE Individual must not bill Medicare independently for the services provided in the comprehensive evaluation. The extensive evaluation (and any re-assessments) is covered by the DCMP. If CMS figures out the recipient is not qualified for the GUIDE Model, the GUIDE Participant can bill for an appropriate Medicare-covered professional service that represents the services rendered.