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However, GUIDE Individuals have the choice, and are not needed, to provide respite through an adult day center or a 24-hour center. Extra GUIDE Break Solutions requirements and details surrounding the payment for such services are specified in the Involvement Contract. GUIDE Individuals in the brand-new program track that are categorized as security net companies will be qualified to receive a one-time infrastructure payment of $75,000 (geographically adjusted by the Geographic Change Aspect [GAF] to cover some of the upfront costs of developing a brand-new dementia care program.

The infrastructure payment is planned for service providers who desire to establish new dementia care programs and need resources to start. GUIDE Individuals qualified as a safeguard service provider based on the percentage of their client population that is dually eligible for Medicare and Medicaid or receive the Part D low-income aid.

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To certify as a GUIDE safeguard supplier, a brand-new program applicant need to have had a Medicare FFS recipient population comprised of at least 36% recipients getting the Part D low-income aid or 33.7% beneficiaries who are dually eligible for Medicare and Medicaid. Accepting the facilities payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE break services will go through recipient cost-sharing.

When a lined up recipient is re-assessed and appointed to a brand-new tier, the GUIDE Individual will be eligible to bill the G-code for the established patient payment rate related to 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 entire worth of their infrastructure payment to CMS.

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After the second efficiency year, GUIDE Participants that withdraw or are terminated from the GUIDE Design are not required 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 replace fee-for-service payment for some existing Medicare Doctor Fee Set Up (PFS) services, including 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 expense under standard Medicare fee-for-service for all services that are not included under the DCMP. Additional details, consisting of a complete list of duplicative codes, is offered in the Demand for Applications (Table 8, pg. 35). CMS might include or remove codes with time to show modifications in PFS billing codes.

The care team might include the recipient's main care company, and if not, the care team is required to identify and share info with the beneficiary's medical care company and experts and detail the care coordination services required to handle the recipient's dementia and co-occurring conditions. CMS will provide GUIDE Individuals information associated with the efficiency measures that CMS utilizes to determine the GUIDE Participant's performance-based modification to the DCMP.GUIDE Individuals in the recognized program track need to be prepared to start furnishing services under the GUIDE Model on July 1, 2024, and bill for those services during the Model Performance Period.

Yes, GUIDE beneficiary and supplier overlap with the Shared Cost savings Program is allowed. The GUIDE Design is developed to be compatible with other CMS models and programs that intend to improve care and decrease costs. CMS believes targeted assistance for individuals with dementia and their caregivers will assist improve population-based care results overall.

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As an example, if an ACO is getting involved in both the GUIDE Model and the Shared Cost Savings Program during Efficiency Year 2024 and then restores and starts 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 Benchmark Year 3. GUIDE Reprieve Service claims will not be counted toward ACO expenses, shared cost savings, nor benchmarking beginning in 2024 for the period of the GUIDE Model.

GUIDE Individuals might take part in multiple CMS Innovation Center designs or Medicare value-based care efforts to accelerate development in care shipment, minimize the expense of care, and improve population health. Individuals and beneficiaries are eligible to participate in the GUIDE Design and the ACO REACH Model. For the rest of CY 2024, ACO REACH will not include the Dementia Care Management Payment (DCMP) or Respite Service declares in the REACH ACOs' overall cost of care expenditures or computation of shared savings/shared losses.

Overlapping participants must follow GUIDE billing guidance as set forth below. ACO REACH claim reductions will not apply to DCMP. ACO REACH will consist of DCMP expenditures for purposes of positioning computations. Nevertheless, GUIDE Reprieve Service claims will not count towards ACO expenditures, shared savings, or benchmarking in 2025 and for the period of the GUIDE Design.

As of January 1, 2025, GUIDE Participants also taking part in ACO REACH should stop billing the Medicare Doctor Cost Schedule Services included under the DCMP (See Exhibition 5 in the GUIDE Payment Methodology Paper (PDF)). Individuals participating in both designs must follow the GUIDE billing requirements in the GUIDE Involvement Arrangement and GUIDE Payment Methodology Paper.

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The GUIDE Participant should not bill Medicare separately for the services supplied in the detailed assessment. The comprehensive evaluation (and any re-assessments) is covered by the DCMP. If CMS determines the recipient is not qualified for the GUIDE Design, the GUIDE Participant can bill for an appropriate Medicare-covered professional service that represents the services rendered.