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GUIDE Individuals have the alternative, and are not required, to make available reprieve through an adult day center or a 24-hour center. Additional GUIDE Respite Providers requirements and details surrounding the payment for such services are specified in the Involvement Arrangement. GUIDE Individuals in the brand-new program track that are categorized as safeguard providers will be eligible to get a one-time facilities payment of $75,000 (geographically adjusted by the Geographic Adjustment Factor [GAF] to cover a few of the upfront costs of establishing a new dementia care program.

The infrastructure payment is meant for suppliers who wish to develop new dementia care programs and require resources to start. GUIDE Participants certified as a security net company based upon 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 qualify as a GUIDE safeguard supplier, a new program candidate must have had a Medicare FFS beneficiary population consisted of at least 36% beneficiaries receiving the Part D low-income aid or 33.7% recipients 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 recipient cost-sharing.

When a lined up recipient is re-assessed and designated to a new tier, the GUIDE Participant will be eligible to bill the G-code for the recognized patient payment rate connected 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 whole value of their facilities payment to CMS.

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After the 2nd performance year, GUIDE Participants that withdraw or are ended from the GUIDE Model are not needed to pay back 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 Charge Arrange (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 model, so GUIDE Participants will continue to bill under standard Medicare fee-for-service for all services that are not consisted of under the DCMP. CMS may add or remove codes over time to reflect modifications in PFS billing codes.

The care group might consist of the beneficiary's primary care supplier, and if not, the care group is required to recognize and share information with the beneficiary's medical care service provider and professionals and lay out the care coordination services required to handle the recipient's dementia and co-occurring conditions. CMS will supply GUIDE Individuals data associated with the efficiency measures that CMS uses to identify the GUIDE Individual's performance-based modification to the DCMP.GUIDE Individuals in the recognized program track should be prepared to start furnishing services under the GUIDE Model on July 1, 2024, and expense for those services during the Model Efficiency Duration.

Yes, GUIDE recipient and provider overlap with the Shared Cost savings Program is permitted. The GUIDE Design is designed to be suitable with other CMS models and programs that aim to improve care and decrease spending. CMS thinks targeted support for individuals with dementia and their caretakers will assist improve population-based care outcomes in general.

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The Dementia Care Management Payment (DCMP), the per beneficiary each month GUIDE payment, will be consisted of in 2024 Shared Savings Program expenditures. When 2024 ends up being a benchmark year, DCMPs will be included in Shared Cost savings Program criteria computations. As an example, if an ACO is getting involved in both the GUIDE Design and the Shared Cost Savings Program during Efficiency Year 2024 and then renews and begins a new arrangement period as of January 1, 2025, that ACO would have their Shared Savings Program criteria based upon 2022, 2023 and 2024, and would have DCMPs counted in Standard Year 3. GUIDE Respite Service claims will not be counted towards ACO expenditures, shared savings, nor benchmarking beginning in 2024 for the duration of the GUIDE Model.

GUIDE Individuals might take part in multiple CMS Innovation Center designs or Medicare value-based care efforts to accelerate innovation in care shipment, decrease the cost of care, and enhance population health. Individuals and recipients are qualified to get involved in the GUIDE Model 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' overall cost of care expenditures or estimation of shared savings/shared losses.

Overlapping participants ought to follow GUIDE billing guidance as stated below. ACO REACH claim decreases will not apply to DCMP. ACO REACH will include DCMP expenses for functions of positioning computations. However, GUIDE Break Service claims will not count toward ACO expenditures, shared cost savings, or benchmarking in 2025 and throughout of the GUIDE Design.

Since January 1, 2025, GUIDE Participants likewise taking part in ACO REACH ought to terminate billing the Medicare Doctor Cost Schedule Solutions included under the DCMP (See Exhibit 5 in the GUIDE Payment Approach Paper (PDF)). Participants taking part in both designs need to follow the GUIDE billing requirements in the GUIDE Involvement Agreement and GUIDE Payment Methodology Paper.

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The GUIDE Participant should not bill Medicare independently for the services offered in the comprehensive evaluation. The detailed evaluation (and any re-assessments) is covered by the DCMP. If CMS identifies the beneficiary is not qualified for the GUIDE Design, the GUIDE Individual can bill for a suitable Medicare-covered expert service that represents the services rendered.