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However, GUIDE Individuals have the option, and are not needed, to provide break through an adult day center or a 24-hour center. Extra GUIDE Reprieve Providers requirements and information surrounding the payment for such services are specified in the Participation Agreement. GUIDE Participants in the brand-new program track that are categorized as safeguard companies will be eligible to receive a one-time infrastructure payment of $75,000 (geographically changed by the Geographic Change Factor [GAF] to cover a few of the upfront costs of establishing a brand-new dementia care program.

The facilities payment is meant for suppliers who wish to establish new dementia care programs and require resources to get going. GUIDE Participants certified as a safety net supplier based on the percentage of their patient population that is dually qualified for Medicare and Medicaid or get the Part D low-income subsidy.

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To certify as a GUIDE security net provider, a brand-new program candidate should have had a Medicare FFS recipient population comprised of at least 36% beneficiaries getting the Part D low-income aid or 33.7% recipients who are dually eligible for Medicare and Medicaid. Accepting the facilities payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE reprieve services will undergo beneficiary cost-sharing.

When an aligned recipient is re-assessed and designated to a new tier, the GUIDE Participant will be qualified to bill the G-code for the recognized client payment rate related to that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the second performance year will be needed to pay back the entire value of their facilities payment to CMS.

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After the 2nd efficiency year, GUIDE Participants that withdraw or are ended from the GUIDE Design are not required to repay the facilities payment. The primary design payment under the GUIDE Model 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 Physician Charge Arrange (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 Design 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 included under the DCMP. CMS may include or get rid of codes over time to show changes in PFS billing codes.

The care team might consist of the beneficiary's medical care supplier, and if not, the care group is needed to recognize and share details with the recipient's medical care service provider and experts and lay out the care coordination services needed to manage the recipient's dementia and co-occurring conditions. CMS will supply GUIDE Participants data connected to the performance measures that CMS utilizes to figure out the GUIDE Individual's performance-based modification to the DCMP.GUIDE Participants in the recognized program track need to be prepared to begin providing services under the GUIDE Design on July 1, 2024, and bill for those services during the Design Efficiency Duration.

Yes, GUIDE recipient and company overlap with the Shared Savings Program is enabled. The GUIDE Model is designed to be suitable with other CMS designs and programs that intend to improve care and decrease spending. CMS believes targeted assistance for people with dementia and their caretakers 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 throughout Efficiency Year 2024 and then renews and starts a brand-new contract period as of January 1, 2025, that ACO would have their Shared Cost 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 savings, nor benchmarking start in 2024 for the duration of the GUIDE Model.

GUIDE Individuals may take part in several CMS Development Center designs or Medicare value-based care initiatives to accelerate innovation in care delivery, reduce the cost of care, and enhance population health. Individuals and recipients 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 Reprieve Service claims in the REACH ACOs' overall expense of care expenditures or calculation of shared savings/shared losses.

Overlapping participants ought to follow GUIDE billing assistance as set forth below. ACO REACH claim reductions will not use to DCMP. ACO REACH will include DCMP expenses for purposes of positioning computations. GUIDE Respite 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 Individuals also taking part in ACO REACH must discontinue billing the Medicare Physician Fee Arrange Services consisted of under the DCMP (See Display 5 in the GUIDE Payment Approach Paper (PDF)). Participants taking part in both designs should follow the GUIDE billing requirements in the GUIDE Participation Arrangement and GUIDE Payment Methodology Paper.

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The GUIDE Individual must not bill Medicare independently for the services supplied in the comprehensive assessment. The extensive 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 a suitable Medicare-covered professional service that corresponds to the services rendered.