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GUIDE Participants have the choice, and are not needed, to make offered reprieve through an adult day center or a 24-hour facility. Additional GUIDE Reprieve Providers requirements and details surrounding the payment for such services are specified in the Involvement Contract.

The facilities payment is intended for companies who desire to establish brand-new dementia care programs and require resources to get going. GUIDE Individuals qualified as a safeguard company based on the percentage of their client 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 safety web provider, a new program candidate should have had a Medicare FFS beneficiary population made up of a minimum of 36% beneficiaries 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 break services will go through beneficiary cost-sharing.

When an aligned beneficiary is re-assessed and assigned to a brand-new tier, the GUIDE Participant will be qualified 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 required to pay back the entire worth of their infrastructure payment to CMS.

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After the 2nd efficiency year, GUIDE Participants that withdraw or are terminated from the GUIDE Model are not needed to repay the infrastructure payment. The main 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 Doctor Charge Schedule (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 Model is not a total-cost-of-care model, so GUIDE Participants will continue to costs under standard Medicare fee-for-service for all services that are not included under the DCMP. CMS might add or get rid of codes over time to reflect changes in PFS billing codes.

The care group may consist of the beneficiary's primary care company, and if not, the care team is required to recognize and share information with the recipient'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 offer GUIDE Participants data connected to the efficiency determines that CMS utilizes to figure out the GUIDE Individual's performance-based change to the DCMP.GUIDE Individuals in the established program track need to be prepared to begin furnishing services under the GUIDE Model on July 1, 2024, and costs for those services during the Model Efficiency Period.

Yes, GUIDE recipient and provider overlap with the Shared Savings Program is permitted. The GUIDE Design is created to be suitable with other CMS models and programs that aim to enhance care and reduce spending. CMS thinks targeted support for individuals with dementia and their caregivers will help improve population-based care outcomes overall.

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As an example, if an ACO is getting involved in both the GUIDE Design and the Shared Cost Savings Program during Performance Year 2024 and then restores and starts a brand-new arrangement period as of January 1, 2025, that ACO would have their Shared Cost savings Program standard based on 2022, 2023 and 2024, and would have DCMPs counted in Criteria Year 3. GUIDE Reprieve Service claims will not be counted towards ACO expenditures, shared cost savings, nor benchmarking start in 2024 for the duration of the GUIDE Design.

GUIDE Individuals might take part in several CMS Innovation Center designs or Medicare value-based care efforts to accelerate development in care delivery, lower the expense of care, and enhance population health. Participants and beneficiaries 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 expense of care expenditures or estimation of shared savings/shared losses.

Overlapping participants need to follow GUIDE billing assistance as set forth below. ACO REACH claim decreases will not apply to DCMP. ACO REACH will include DCMP expenses for purposes of positioning estimations. However, GUIDE Respite Service claims will not count towards ACO expenses, shared cost savings, or benchmarking in 2025 and for the duration of the GUIDE Model.

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

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The GUIDE Participant 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 determines the beneficiary is not qualified for the GUIDE Model, the GUIDE Individual can bill for an appropriate Medicare-covered expert service that corresponds to the services rendered.