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GUIDE Individuals have the alternative, and are not needed, to make readily available respite through an adult day center or a 24-hour center. Additional GUIDE Break Solutions requirements and details surrounding the payment for such services are specified in the Participation Agreement. GUIDE Participants in the new program track that are classified as safeguard suppliers will be eligible to receive a one-time infrastructure payment of $75,000 (geographically changed by the Geographic Modification Element [GAF] to cover some of the upfront costs of establishing a brand-new dementia care program.

The facilities payment is intended for suppliers who desire to develop new dementia care programs and require resources to get going. GUIDE Participants qualified as a safeguard supplier based on the percentage of their client population that is dually eligible for Medicare and Medicaid or get the Part D low-income aid.

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To certify as a GUIDE safeguard service provider, a new program applicant must have had a Medicare FFS beneficiary population comprised of at least 36% beneficiaries receiving the Part D low-income aid or 33.7% recipients who are dually qualified for Medicare and Medicaid. Accepting the infrastructure payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE reprieve services will be subject to beneficiary cost-sharing.

When a lined up beneficiary is re-assessed and appointed to a brand-new tier, the GUIDE Individual will be qualified to bill the G-code for the established client payment rate associated with that tier the following month. GUIDE Individuals that withdraw or are terminated before the start of the second efficiency year will be needed to repay the entire value of their infrastructure payment to CMS.

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After the second efficiency year, GUIDE Individuals that withdraw or are ended from the GUIDE Design are not needed to repay 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 Charge Arrange (PFS) services, consisting of chronic care management and principal care management, transitional care management, advance care planning, 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 expense 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 offered in the Request for Applications (Table 8, pg. 35). CMS might include or get rid of codes over time to show modifications in PFS billing codes.

The care team might include the beneficiary's medical care service provider, and if not, the care team is needed to recognize and share info with the beneficiary's primary care service provider and professionals and describe the care coordination services required to manage the beneficiary's dementia and co-occurring conditions. CMS will offer GUIDE Individuals data connected to the performance determines that CMS uses to figure out the GUIDE Individual's performance-based modification to the DCMP.GUIDE Individuals in the recognized program track need to be prepared to start providing services under the GUIDE Design on July 1, 2024, and expense for those services during the Model Performance Duration.

Yes, GUIDE recipient and provider overlap with the Shared Savings Program is allowed. The GUIDE Design is developed to be compatible with other CMS designs and programs that aim to improve care and decrease costs. CMS thinks targeted support for people with dementia and their caregivers will assist improve population-based care results in general.

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The Dementia Care Management Payment (DCMP), the per recipient each month GUIDE payment, will be included in 2024 Shared Savings Program expenses. When 2024 becomes a benchmark year, DCMPs will be included in Shared Cost savings Program criteria estimations. As an example, if an ACO is taking part in both the GUIDE Design and the Shared Cost Savings Program during Performance Year 2024 and after that restores and begins a brand-new arrangement period since January 1, 2025, that ACO would have their Shared Cost savings Program benchmark based upon 2022, 2023 and 2024, and would have DCMPs counted in Benchmark Year 3. Nevertheless, GUIDE Reprieve Service claims will not be counted towards ACO expenses, shared cost savings, nor benchmarking start in 2024 throughout of the GUIDE Design.

GUIDE Individuals may take part in numerous CMS Innovation Center models or Medicare value-based care initiatives to accelerate innovation in care shipment, minimize the cost of care, and improve population health. Participants and recipients are eligible to take part in the GUIDE Design and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not consist of the Dementia Care Management Payment (DCMP) or Reprieve Service claims in the REACH ACOs' total cost of care expenses or computation of shared savings/shared losses.

Overlapping individuals ought to follow GUIDE billing assistance as set forth listed below. GUIDE Respite Service claims will not count towards ACO expenditures, shared cost savings, or benchmarking in 2025 and for the duration of the GUIDE Design.

Since January 1, 2025, GUIDE Participants also participating in ACO REACH should cease billing the Medicare Doctor Charge Arrange Solutions included under the DCMP (See Display 5 in the GUIDE Payment Methodology Paper (PDF)). Individuals taking part in both designs should follow the GUIDE billing requirements in the GUIDE Participation Agreement and GUIDE Payment Approach Paper.

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The GUIDE Individual should not bill Medicare individually for the services provided in the comprehensive evaluation. The extensive assessment (and any re-assessments) is covered by the DCMP. If CMS figures out the beneficiary is not qualified for the GUIDE Design, the GUIDE Individual can bill for a proper Medicare-covered expert service that corresponds to the services rendered.