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GUIDE Individuals have the alternative, and are not required, to make available reprieve through an adult day center or a 24-hour center. Additional GUIDE Reprieve Providers requirements and information surrounding the payment for such services are defined in the Involvement Arrangement.

The infrastructure payment is intended for suppliers who wish to establish new dementia care programs and need resources to get begun. GUIDE Participants certified as a safety net provider based on the percentage of their patient population that is dually qualified for Medicare and Medicaid or receive the Part D low-income aid.

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To qualify as a GUIDE safeguard provider, a new program applicant must have had a Medicare FFS recipient population made up 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 respite services will undergo beneficiary cost-sharing.

When an aligned recipient is re-assessed and appointed to a brand-new tier, the GUIDE Individual will be qualified to bill the G-code for the recognized patient payment rate associated with that tier the following month. GUIDE Individuals that withdraw or are terminated before the start of the 2nd performance year will be needed to pay back the whole value of their infrastructure payment to CMS.

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After the 2nd efficiency year, GUIDE Individuals that withdraw or are ended from the GUIDE Design are not required to repay the infrastructure payment. The main model payment under the GUIDE Model 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 Doctor Charge Schedule (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 costs under standard Medicare fee-for-service for all services that are not consisted of under the DCMP. CMS might add or eliminate codes over time to show modifications in PFS billing codes.

The care group may include the beneficiary's primary care provider, and if not, the care group is needed to identify and share information with the beneficiary's medical care service provider and professionals and describe the care coordination services required to handle the beneficiary's dementia and co-occurring conditions. CMS will provide GUIDE Participants information connected to the performance determines that CMS uses to figure out the GUIDE Participant's performance-based adjustment to the DCMP.GUIDE Individuals in the established program track must be prepared to start providing services under the GUIDE Model on July 1, 2024, and bill for those services throughout the Design Performance Period.

Yes, GUIDE recipient and company overlap with the Shared Cost savings Program is enabled. The GUIDE Design is created to be suitable with other CMS models and programs that intend to improve care and reduce spending. CMS believes targeted support for people with dementia and their caretakers will assist enhance population-based care outcomes overall.

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As an example, if an ACO is participating in both the GUIDE Design and the Shared Cost Savings Program during Performance Year 2024 and then renews and begins a new contract 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 towards ACO expenses, shared savings, nor benchmarking start in 2024 for the period of the GUIDE Model.

GUIDE Individuals may take part in several CMS Development Center models or Medicare value-based care efforts to accelerate innovation in care shipment, minimize the cost of care, and enhance 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 consist of the Dementia Care Management Payment (DCMP) or Respite Service declares in the REACH ACOs' overall cost of care expenses or computation of shared savings/shared losses.

Overlapping individuals must 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 Design.

As of January 1, 2025, GUIDE Individuals also taking part in ACO REACH must discontinue billing the Medicare Doctor Charge Schedule Services included under the DCMP (See Display 5 in the GUIDE Payment Methodology Paper (PDF)). Participants taking part in both designs should follow the GUIDE billing requirements in the GUIDE Participation Contract and GUIDE Payment Approach Paper.

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The GUIDE Participant must not bill Medicare separately for the services provided in the extensive evaluation. The comprehensive evaluation (and any re-assessments) is covered by the DCMP. If CMS identifies the beneficiary is not qualified for the GUIDE Design, the GUIDE Individual can bill for a suitable Medicare-covered professional service that represents the services rendered.