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GUIDE Participants have the alternative, and are not required, to make offered respite through an adult day center or a 24-hour facility. Additional GUIDE Reprieve Solutions requirements and information surrounding the payment for such services are defined in the Involvement Agreement.

The infrastructure payment is planned for companies who want to establish new dementia care programs and require resources to start. GUIDE Participants qualified as a safety net company based on the proportion of their client population that is dually qualified for Medicare and Medicaid or get the Part D low-income subsidy.

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To qualify as a GUIDE safeguard service provider, a brand-new program applicant must have had a Medicare FFS beneficiary population consisted of at least 36% recipients getting 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 break services will undergo recipient cost-sharing.

When an aligned beneficiary is re-assessed and assigned to a brand-new tier, the GUIDE Participant will be eligible to bill the G-code for the established client payment rate related to that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the second performance year will be needed to repay the entire value of their facilities payment to CMS.

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After the second efficiency year, GUIDE Individuals that withdraw or are ended from the GUIDE Design are not needed to pay back the infrastructure payment. The primary 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 change fee-for-service payment for some existing Medicare Physician Charge Set Up (PFS) services, consisting of 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 traditional Medicare fee-for-service for all services that are not included under the DCMP. CMS might include or get rid of codes over time to show modifications in PFS billing codes.

The care team may consist of the beneficiary's main care company, and if not, the care group is required to identify and share info with the beneficiary's main care service provider and professionals and describe the care coordination services needed to handle the recipient's dementia and co-occurring conditions. CMS will provide GUIDE Participants data related to the performance measures that CMS utilizes to identify the GUIDE Individual's performance-based change to the DCMP.GUIDE Individuals in the established program track need to be prepared to start furnishing services under the GUIDE Model on July 1, 2024, and costs for those services during the Model Efficiency Duration.

Yes, GUIDE beneficiary and provider overlap with the Shared Cost savings Program is permitted. The GUIDE Model is developed to be suitable with other CMS models and programs that intend to enhance care and lower spending. CMS believes targeted assistance for people with dementia and their caregivers will assist improve population-based care results in general.

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The Dementia Care Management Payment (DCMP), the per beneficiary each month GUIDE payment, will be included in 2024 Shared Cost savings Program expenses. When 2024 becomes a benchmark year, DCMPs will be included in Shared Cost savings Program standard computations. As an example, if an ACO is getting involved in both the GUIDE Model and the Shared Savings Program during Performance Year 2024 and then renews and starts a new arrangement period as of January 1, 2025, that ACO would have their Shared Cost savings Program criteria based upon 2022, 2023 and 2024, and would have DCMPs counted in Benchmark Year 3. GUIDE Break Service claims will not be counted toward ACO expenditures, shared savings, nor benchmarking start in 2024 for the period of the GUIDE Design.

GUIDE Individuals might take part in several CMS Development Center models or Medicare value-based care initiatives to speed up development in care shipment, lower the expense of care, and enhance population health. Participants and recipients are qualified to take part in the GUIDE Design and the ACO REACH Model. For the rest of CY 2024, ACO REACH will not include 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 must follow GUIDE billing guidance as stated below. ACO REACH claim reductions will not apply to DCMP. ACO REACH will consist of DCMP expenses for functions of positioning estimations. However, GUIDE Reprieve Service claims will not count toward ACO expenses, shared cost savings, or benchmarking in 2025 and throughout of the GUIDE Design.

Since January 1, 2025, GUIDE Individuals also taking part in ACO REACH should stop billing the Medicare Doctor Fee Schedule Services included under the DCMP (See Exhibition 5 in the GUIDE Payment Approach Paper (PDF)). Individuals getting involved in both designs need to follow the GUIDE billing requirements in the GUIDE Participation Contract and GUIDE Payment Method Paper.

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The GUIDE Participant need to not bill Medicare individually for the services provided in the extensive evaluation. The extensive assessment (and any re-assessments) is covered by the DCMP. If CMS figures out the recipient is not eligible for the GUIDE Design, the GUIDE Participant can bill for a suitable Medicare-covered professional service that represents the services rendered.