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GUIDE Individuals have the alternative, and are not needed, to make readily available break through an adult day center or a 24-hour center. Extra GUIDE Respite Solutions requirements and details surrounding the payment for such services are defined in the Participation Agreement.

The facilities payment is meant for service providers who desire to develop new dementia care programs and require resources to get going. GUIDE Individuals certified as a safeguard provider based upon the percentage of their patient population that is dually qualified for Medicare and Medicaid or get the Part D low-income subsidy.

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To certify as a GUIDE safety internet provider, a new program candidate must have had a Medicare FFS beneficiary population consisted of at least 36% beneficiaries getting the Part D low-income aid or 33.7% recipients who are dually qualified for Medicare and Medicaid. Accepting the facilities payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE reprieve services will go through recipient cost-sharing.

When an aligned beneficiary is re-assessed and assigned to a new tier, the GUIDE Participant will be qualified to bill the G-code for the established client payment rate associated with that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the 2nd performance year will be required to repay the entire worth of their facilities payment to CMS.

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After the 2nd performance year, GUIDE Individuals that withdraw or are ended from the GUIDE Model are not needed to repay the facilities payment. The main design 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 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 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 included under the DCMP. CMS may add or eliminate codes over time to reflect changes in PFS billing codes.

The care group might include the recipient's medical care service provider, and if not, the care team is required to determine and share info with the recipient's main care provider and professionals and describe the care coordination services required to handle the beneficiary's dementia and co-occurring conditions. CMS will supply GUIDE Individuals information associated with the performance measures that CMS utilizes 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 Design Efficiency Duration.

Yes, GUIDE beneficiary and provider overlap with the Shared Cost savings Program is enabled. The GUIDE Model is designed to be compatible with other CMS designs and programs that intend to enhance care and minimize spending. CMS believes targeted support for people with dementia and their caretakers will help improve population-based care results in general.

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As an example, if an ACO is taking part in both the GUIDE Model and the Shared Cost Savings Program throughout Efficiency Year 2024 and then restores and begins a new agreement duration as of January 1, 2025, that ACO would have their Shared Savings Program benchmark based on 2022, 2023 and 2024, and would have DCMPs counted in Standard Year 3. GUIDE Reprieve Service claims will not be counted toward ACO expenditures, shared cost savings, nor benchmarking start in 2024 for the duration of the GUIDE Model.

GUIDE Participants might take part in several CMS Innovation Center designs or Medicare value-based care initiatives to speed up development in care delivery, reduce the expense of care, and improve population health. Individuals and beneficiaries are eligible to take part in the GUIDE Design and the ACO REACH Design. 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 cost of care expenditures or calculation of shared savings/shared losses.

Overlapping participants should 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 period of the GUIDE Model.

Since January 1, 2025, GUIDE Participants also getting involved in ACO REACH need to terminate billing the Medicare Physician Cost Set up Providers consisted of under the DCMP (See Exhibition 5 in the GUIDE Payment Method Paper (PDF)). Participants taking part in both designs need to follow the GUIDE billing requirements in the GUIDE Participation Contract and GUIDE Payment Methodology Paper.

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