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However, GUIDE Participants have the option, and are not required, to make readily available break through an adult day center or a 24-hour facility. Extra GUIDE Reprieve Services requirements and details surrounding the payment for such services are defined in the Participation Arrangement. GUIDE Participants in the brand-new program track that are categorized as safety net providers will be eligible to get a one-time infrastructure payment of $75,000 (geographically adjusted by the Geographic Adjustment Aspect [GAF] to cover a few of the upfront expenses of developing a new dementia care program.

The facilities payment is meant for providers who want to establish brand-new dementia care programs and need resources to get going. GUIDE Participants certified as a security net company based upon the proportion of their patient population that is dually qualified for Medicare and Medicaid or receive the Part D low-income subsidy.

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To qualify as a GUIDE safeguard service provider, a new program applicant need to have had a Medicare FFS beneficiary population made up of a minimum of 36% recipients getting the Part D low-income aid 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 respite services will be subject to beneficiary cost-sharing.

When an aligned beneficiary is re-assessed and designated to a new tier, the GUIDE Individual will be qualified to bill the G-code for the established 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 repay the whole worth of their facilities payment to CMS.

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After the 2nd performance year, GUIDE Individuals that withdraw or are terminated from the GUIDE Model are not required to pay back the infrastructure 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 Doctor Cost Arrange (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 Design is not a total-cost-of-care model, so GUIDE Individuals will continue to bill under conventional Medicare fee-for-service for all services that are not included under the DCMP. Additional info, including a total list of duplicative codes, is available in the Ask for Applications (Table 8, pg. 35). CMS may add or eliminate codes with time to show changes in PFS billing codes.

The care group might include the recipient's medical care provider, and if not, the care team is required to identify and share information with the beneficiary's main care supplier and professionals and detail the care coordination services required to handle the beneficiary's dementia and co-occurring conditions. CMS will supply GUIDE Individuals information related to the efficiency determines that CMS uses to figure out the GUIDE Participant's performance-based modification to the DCMP.GUIDE Participants in the established program track should be prepared to begin providing services under the GUIDE Design on July 1, 2024, and expense for those services during the Design Performance Period.

Yes, GUIDE recipient and service provider overlap with the Shared Cost savings Program is permitted. The GUIDE Design is developed to be suitable with other CMS designs and programs that aim to enhance care and minimize spending. CMS believes targeted support for people with dementia and their caregivers will help improve population-based care results in general.

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The Dementia Care Management Payment (DCMP), the per recipient per month GUIDE payment, will be included in 2024 Shared Cost savings Program expenditures. When 2024 becomes a benchmark year, DCMPs will be consisted of in Shared Cost savings Program benchmark calculations. 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 after that restores and starts a new contract period as of January 1, 2025, that ACO would have their Shared Cost savings Program benchmark based on 2022, 2023 and 2024, and would have DCMPs counted in Standard Year 3. However, GUIDE Reprieve Service claims will not be counted towards ACO expenses, shared savings, nor benchmarking beginning in 2024 for the duration of the GUIDE Design.

GUIDE Participants may take part in numerous CMS Innovation Center designs or Medicare value-based care efforts to speed up development in care delivery, lower the expense of care, and improve population health. Individuals and beneficiaries are qualified to participate in the GUIDE Model 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 estimation of shared savings/shared losses.

Overlapping individuals must follow GUIDE billing assistance as set forth below. GUIDE Reprieve Service claims will not count toward 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 stop billing the Medicare Doctor Fee Arrange Solutions included under the DCMP (See Exhibit 5 in the GUIDE Payment Approach Paper (PDF)). Individuals 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 Participant should not bill Medicare separately for the services offered in the comprehensive evaluation. 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 proper Medicare-covered expert service that corresponds to the services rendered.