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GUIDE Participants have the option, and are not needed, to make available break through an adult day center or a 24-hour facility. Additional GUIDE Reprieve Providers requirements and details surrounding the payment for such services are defined in the Involvement Agreement.

The facilities payment is meant for providers who wish to develop new dementia care programs and require resources to get going. GUIDE Participants qualified as a safeguard provider based upon the proportion of their client population that is dually qualified for Medicare and Medicaid or get the Part D low-income aid.

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To certify as a GUIDE security web supplier, a new program candidate must have had a Medicare FFS beneficiary population made up of at least 36% recipients getting the Part D low-income aid or 33.7% beneficiaries who are dually qualified for Medicare and Medicaid. Accepting the facilities payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE break services will undergo beneficiary cost-sharing.

When an aligned recipient is re-assessed and designated to a brand-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 second efficiency year will be required to repay the entire worth of their facilities 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 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 change fee-for-service payment for some existing Medicare Physician Cost 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 Model is not a total-cost-of-care design, so GUIDE Individuals will continue to bill under standard Medicare fee-for-service for all services that are not consisted of under the DCMP. CMS may add or eliminate codes over time to reflect modifications in PFS billing codes.

The care group might consist of the beneficiary's medical care company, and if not, the care team is required to identify and share details with the beneficiary's medical care company and professionals and lay out the care coordination services required to manage the beneficiary's dementia and co-occurring conditions. CMS will offer GUIDE Participants data associated with the efficiency determines that CMS utilizes to determine the GUIDE Individual's performance-based adjustment to the DCMP.GUIDE Individuals in the recognized program track need to be prepared to begin providing services under the GUIDE Design on July 1, 2024, and expense for those services throughout the Model Efficiency Period.

Yes, GUIDE beneficiary and provider overlap with the Shared Cost savings Program is permitted. The GUIDE Model is developed to be compatible with other CMS designs and programs that aim to improve care and reduce spending. CMS believes targeted support for people with dementia and their caregivers will assist improve population-based care results in general.

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As an example, if an ACO is getting involved in both the GUIDE Model and the Shared Cost Savings Program throughout Efficiency Year 2024 and then restores and starts a new agreement duration 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 Break Service claims will not be counted toward ACO expenses, shared cost savings, nor benchmarking beginning in 2024 for the duration of the GUIDE Model.

GUIDE Individuals may take part in several CMS Development Center models or Medicare value-based care initiatives to speed up innovation in care shipment, lower the expense of care, and improve population health. Individuals and beneficiaries are qualified 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 Break Service claims in the REACH ACOs' overall expense of care expenditures or calculation of shared savings/shared losses.

Overlapping individuals should follow GUIDE billing guidance as set forth below. GUIDE Break Service claims will not count towards ACO expenses, shared cost savings, or benchmarking in 2025 and for the period of the GUIDE Model.

As of January 1, 2025, GUIDE Participants also taking part in ACO REACH ought to cease billing the Medicare Doctor Fee Arrange Providers consisted of under the DCMP (See Exhibition 5 in the GUIDE Payment Method Paper (PDF)). Participants taking part in both designs must follow the GUIDE billing requirements in the GUIDE Involvement Arrangement and GUIDE Payment Method Paper.

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The GUIDE Participant must not bill Medicare independently for the services supplied in the extensive evaluation. The detailed 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 Participant can bill for an appropriate Medicare-covered professional service that corresponds to the services rendered.