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GUIDE Participants have the option, and are not needed, to make offered reprieve through an adult day center or a 24-hour center. Additional GUIDE Respite Services requirements and information surrounding the payment for such services are defined in the Involvement Arrangement.

The infrastructure payment is planned for providers who wish to establish new dementia care programs and need resources to begin. GUIDE Participants certified as a safeguard company based upon the proportion of their patient 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 provider, a new program candidate must have had a Medicare FFS recipient population consisted of a minimum of 36% beneficiaries receiving the Part D low-income aid or 33.7% beneficiaries 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 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 efficiency year will be needed to pay back the whole worth of their infrastructure 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 pay back the infrastructure payment. The primary 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 Physician Charge Arrange (PFS) services, consisting of persistent care management and primary care management, transitional care management, advance care preparation, and technology-based check-ins.

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The GUIDE Design is not a total-cost-of-care design, so GUIDE Individuals will continue to expense under traditional 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 may include the recipient's medical care provider, and if not, the care team is needed to identify and share info with the beneficiary's medical care service provider and professionals and outline the care coordination services needed to handle the recipient's dementia and co-occurring conditions. CMS will provide GUIDE Participants information related to the performance determines that CMS utilizes to identify the GUIDE Participant's performance-based change 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 expense for those services throughout the Model Efficiency Duration.

Yes, GUIDE beneficiary and supplier overlap with the Shared Savings Program is allowed. The GUIDE Model is developed to be suitable with other CMS designs and programs that aim to improve care and lower spending. 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 taking part in both the GUIDE Design and the Shared Cost Savings Program during Efficiency Year 2024 and then restores and starts 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 Criteria Year 3. GUIDE Reprieve Service claims will not be counted towards ACO expenditures, shared cost savings, nor benchmarking start in 2024 for the period of the GUIDE Design.

GUIDE Individuals may take part in multiple CMS Innovation Center models or Medicare value-based care initiatives to accelerate innovation in care shipment, lower the cost of care, and enhance population health. Participants and beneficiaries are qualified 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 Break Service declares in the REACH ACOs' total cost of care expenditures or computation of shared savings/shared losses.

Overlapping participants ought to follow GUIDE billing assistance as set forth listed below. GUIDE Break Service claims will not count toward ACO expenses, shared 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 must stop billing the Medicare Physician Cost Arrange Services included under the DCMP (See Exhibit 5 in the GUIDE Payment Methodology Paper (PDF)). Participants 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 separately for the services offered in the comprehensive evaluation. The comprehensive assessment (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 an appropriate Medicare-covered professional service that represents the services rendered.