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However, GUIDE Individuals have the alternative, and are not required, to offer respite through an adult day center or a 24-hour facility. Additional GUIDE Reprieve Solutions requirements and details surrounding the payment for such services are defined in the Involvement Arrangement. GUIDE Individuals in the brand-new program track that are classified as safeguard service providers will be eligible to receive a one-time facilities payment of $75,000 (geographically changed by the Geographic Adjustment Element [GAF] to cover a few of the upfront expenses of establishing a new dementia care program.

The infrastructure payment is meant for suppliers who want to develop brand-new dementia care programs and require resources to get started. GUIDE Participants qualified as a safeguard company based on the percentage of their patient population that is dually eligible for Medicare and Medicaid or get the Part D low-income subsidy.

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To certify as a GUIDE safeguard service provider, a new program applicant should have had a Medicare FFS recipient population consisted of at least 36% recipients getting 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 break services will be subject to beneficiary cost-sharing.

When an aligned recipient is re-assessed and designated to a new tier, the GUIDE Participant will be eligible to bill the G-code for the recognized client payment rate associated with that tier the following month. GUIDE Individuals that withdraw or are terminated before the start of the 2nd efficiency year will be needed to pay back the whole value of their facilities payment to CMS.

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After the second efficiency year, GUIDE Individuals that withdraw or are terminated from the GUIDE Design are not needed to repay the infrastructure payment. The main 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 Arrange (PFS) services, consisting of persistent care management and primary 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 expense under traditional Medicare fee-for-service for all services that are not consisted of under the DCMP. Extra details, consisting of a total list of duplicative codes, is offered in the Request for Applications (Table 8, pg. 35). CMS might add or remove codes gradually to show changes in PFS billing codes.

The care group might include the beneficiary's primary care service provider, and if not, the care team is needed to determine and share details with the recipient's medical care supplier and experts and outline the care coordination services required to handle the recipient's dementia and co-occurring conditions. CMS will supply GUIDE Participants information connected to the performance measures that CMS utilizes to determine the GUIDE Participant's performance-based adjustment to the DCMP.GUIDE Individuals in the recognized program track should be prepared to begin furnishing services under the GUIDE Model on July 1, 2024, and costs for those services during the Design Efficiency Period.

Yes, GUIDE beneficiary and supplier overlap with the Shared Savings Program is allowed. The GUIDE Model is designed to be compatible with other CMS designs and programs that aim to enhance care and decrease spending. CMS believes targeted assistance for people with dementia and their caregivers will assist improve population-based care results overall.

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As an example, if an ACO is taking part in both the GUIDE Model and the Shared Savings Program throughout Performance Year 2024 and then renews and begins a new agreement period as of January 1, 2025, that ACO would have their Shared Savings Program standard based on 2022, 2023 and 2024, and would have DCMPs counted in Benchmark Year 3. GUIDE Break Service claims will not be counted toward ACO expenses, shared savings, nor benchmarking start in 2024 for the duration of the GUIDE Design.

GUIDE Individuals might participate in numerous CMS Innovation Center models or Medicare value-based care efforts to accelerate innovation in care shipment, reduce the cost of care, and enhance population health. Participants and recipients are qualified to get involved in the GUIDE Design and the ACO REACH Model. 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' total cost of care expenditures or computation of shared savings/shared losses.

Overlapping individuals need to follow GUIDE billing guidance as set forth below. GUIDE Break Service claims will not count towards ACO expenditures, shared 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 ought to discontinue billing the Medicare Doctor Fee Arrange Services consisted of under the DCMP (See Exhibition 5 in the GUIDE Payment Method Paper (PDF)). Participants taking part in both designs should follow the GUIDE billing requirements in the GUIDE Participation Arrangement and GUIDE Payment Methodology Paper.

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The GUIDE Individual should not bill Medicare separately for the services supplied in the extensive assessment. The thorough assessment (and any re-assessments) is covered by the DCMP. If CMS determines the recipient is not eligible for the GUIDE Model, the GUIDE Individual can bill for a suitable Medicare-covered professional service that represents the services rendered.