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GUIDE Individuals have the option, and are not required, to make readily available break through an adult day center or a 24-hour center. Additional GUIDE Respite Providers requirements and information surrounding the payment for such services are defined in the Participation Arrangement. GUIDE Individuals in the new program track that are classified as safeguard suppliers will be qualified to get a one-time infrastructure payment of $75,000 (geographically changed by the Geographic Adjustment Element [GAF] to cover a few of the upfront expenses of developing a brand-new dementia care program.

The facilities payment is planned for suppliers who want to establish new dementia care programs and need resources to begin. GUIDE Participants qualified as a safeguard provider based on the percentage of their client 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 provider, a new program applicant should have had a Medicare FFS beneficiary population comprised of at least 36% recipients receiving the Part D low-income subsidy 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 respite services will undergo recipient cost-sharing.

When a lined up recipient is re-assessed and designated to a new tier, the GUIDE Individual will be eligible to bill the G-code for the recognized client payment rate connected with that tier the following month. GUIDE Participants that withdraw or are ended before the start of the second efficiency year will be needed to repay the whole value of their infrastructure payment to CMS.

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After the 2nd performance year, GUIDE Participants that withdraw or are ended 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 Charge Schedule (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 model, so GUIDE Participants will continue to costs under traditional Medicare fee-for-service for all services that are not consisted of under the DCMP. CMS may include or remove codes over time to show changes in PFS billing codes.

The care group may include the beneficiary's medical care supplier, and if not, the care team is required to determine and share info with the recipient's main care company and specialists and detail the care coordination services required to manage the recipient's dementia and co-occurring conditions. CMS will supply GUIDE Individuals information associated with the efficiency measures that CMS utilizes to identify the GUIDE Participant's performance-based adjustment to the DCMP.GUIDE Individuals in the established program track ought to be prepared to start furnishing services under the GUIDE Model on July 1, 2024, and costs for those services throughout the Design Performance Duration.

Yes, GUIDE beneficiary and supplier overlap with the Shared Savings Program is enabled. The GUIDE Model is created to be compatible with other CMS designs and programs that aim to improve care and reduce costs. CMS thinks targeted support for people with dementia and their caregivers will assist improve population-based care outcomes in general.

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

GUIDE Individuals may take part in several CMS Innovation Center models or Medicare value-based care initiatives to speed up innovation in care delivery, reduce the cost of care, and enhance 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 Respite Service declares in the REACH ACOs' total cost of care expenses or estimation of shared savings/shared losses.

Overlapping individuals ought to follow GUIDE billing guidance as set forth listed below. GUIDE Respite Service claims will not count toward ACO expenditures, shared savings, or benchmarking in 2025 and for the period of the GUIDE Model.

Since January 1, 2025, GUIDE Participants likewise participating in ACO REACH need to cease billing the Medicare Physician Fee Schedule Providers included under the DCMP (See Exhibit 5 in the GUIDE Payment Methodology Paper (PDF)). Participants taking part in both designs need to follow the GUIDE billing requirements in the GUIDE Participation Arrangement and GUIDE Payment Approach Paper.

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The GUIDE Individual should not bill Medicare independently for the services provided in the extensive assessment. The comprehensive assessment (and any re-assessments) is covered by the DCMP. If CMS determines the recipient is not qualified for the GUIDE Model, the GUIDE Individual can bill for a proper Medicare-covered expert service that corresponds to the services rendered.