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GUIDE Individuals have the choice, and are not needed, to make readily available respite through an adult day center or a 24-hour center. Additional GUIDE Respite Providers requirements and details surrounding the payment for such services are defined in the Participation Agreement. GUIDE Individuals in the brand-new program track that are classified as safeguard providers will be qualified to get a one-time facilities payment of $75,000 (geographically adjusted by the Geographic Modification Factor [GAF] to cover some of the upfront costs of developing a new dementia care program.

The facilities payment is planned for providers who want to establish brand-new dementia care programs and require resources to begin. GUIDE Individuals certified as a safeguard service provider based on the proportion of their patient population that is dually eligible for Medicare and Medicaid or get the Part D low-income aid.

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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 consisted of at least 36% recipients receiving the Part D low-income subsidy 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 undergo beneficiary cost-sharing.

When an aligned beneficiary is re-assessed and designated to a new tier, the GUIDE Participant will be qualified to bill the G-code for the established client payment rate connected with that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the second performance year will be required to pay back the entire value 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 needed to pay back the infrastructure payment. The primary 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 change fee-for-service payment for some existing Medicare Physician Charge Arrange (PFS) services, consisting of persistent care management and primary care management, transitional care management, advance care planning, and technology-based check-ins.

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The GUIDE Model is not a total-cost-of-care model, so GUIDE Individuals will continue to bill under traditional 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 modifications in PFS billing codes.

The care team may consist of the beneficiary's medical care provider, and if not, the care group is needed to determine and share information with the beneficiary's medical care service provider and experts and lay out the care coordination services required to handle the beneficiary's dementia and co-occurring conditions. CMS will provide GUIDE Individuals information related to the performance measures that CMS utilizes to figure out the GUIDE Participant's performance-based adjustment to the DCMP.GUIDE Participants in the established program track ought to be prepared to start furnishing services under the GUIDE Model on July 1, 2024, and expense for those services throughout the Model Efficiency Period.

Yes, GUIDE beneficiary and supplier overlap with the Shared Savings Program is permitted. The GUIDE Design is created to be suitable with other CMS designs and programs that aim to enhance care and minimize costs. CMS thinks targeted support for people with dementia and their caregivers will help improve population-based care results overall.

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The Dementia Care Management Payment (DCMP), the per beneficiary per month GUIDE payment, will be consisted of in 2024 Shared Savings Program expenses. When 2024 becomes a benchmark year, DCMPs will be consisted of in Shared Savings Program criteria calculations. 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 renews and begins a brand-new contract period as of January 1, 2025, that ACO would have their Shared Savings Program standard based on 2022, 2023 and 2024, and would have DCMPs counted in Benchmark Year 3. Nevertheless, GUIDE Respite Service claims will not be counted towards ACO expenses, shared cost savings, nor benchmarking beginning in 2024 for the period of the GUIDE Design.

GUIDE Participants may get involved in several CMS Development Center designs or Medicare value-based care initiatives to accelerate innovation in care delivery, lower the cost of care, and enhance population health. Individuals and beneficiaries are eligible to take part 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 declares in the REACH ACOs' total expense of care expenditures or calculation of shared savings/shared losses.

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

As of January 1, 2025, GUIDE Participants also taking part in ACO REACH need to discontinue billing the Medicare Physician Fee Arrange Services consisted of under the DCMP (See Display 5 in the GUIDE Payment Approach Paper (PDF)). Individuals taking part in both models need to follow the GUIDE billing requirements in the GUIDE Involvement Agreement and GUIDE Payment Approach Paper.

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The GUIDE Participant should not bill Medicare independently for the services supplied in the detailed evaluation. The comprehensive evaluation (and any re-assessments) is covered by the DCMP. If CMS identifies the recipient is not eligible for the GUIDE Design, the GUIDE Participant can bill for an appropriate Medicare-covered expert service that corresponds to the services rendered.