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GUIDE Individuals have the option, and are not needed, to make available break through an adult day center or a 24-hour facility. Additional GUIDE Break Providers requirements and details surrounding the payment for such services are defined in the Participation Contract. GUIDE Individuals in the brand-new program track that are classified as safety net suppliers will be qualified to receive a one-time facilities payment of $75,000 (geographically adjusted by the Geographic Modification Factor [GAF] to cover a few of the in advance costs of establishing a new dementia care program.

The facilities payment is intended for providers who want to establish brand-new dementia care programs and need resources to get going. GUIDE Individuals certified as a safeguard supplier based upon the percentage of their client population that is dually qualified for Medicare and Medicaid or receive the Part D low-income subsidy.

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To certify as a GUIDE security internet supplier, a new program applicant need to have had a Medicare FFS recipient population consisted of at least 36% recipients receiving the Part D low-income aid or 33.7% recipients who are dually eligible for Medicare and Medicaid. Accepting the infrastructure payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE respite services will be subject to recipient cost-sharing.

When a lined up beneficiary is re-assessed and assigned to a brand-new tier, the GUIDE Individual will be qualified to bill the G-code for the established client payment rate related to that tier the following month. GUIDE Individuals that withdraw or are ended before the start of the second efficiency year will be needed to pay back the whole value of their infrastructure payment to CMS.

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After the second performance year, GUIDE Participants that withdraw or are ended from the GUIDE Design are not needed to repay the infrastructure payment. The main 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 Fee Schedule (PFS) services, consisting of persistent 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 bill under conventional Medicare fee-for-service for all services that are not included under the DCMP. Additional info, consisting of a total list of duplicative codes, is readily available in the Ask for Applications (Table 8, pg. 35). CMS may add or eliminate codes gradually to show modifications in PFS billing codes.

The care group might include the beneficiary's main care provider, and if not, the care group is needed to determine and share details with the beneficiary's main care company and experts and outline the care coordination services needed to manage the beneficiary's dementia and co-occurring conditions. CMS will supply GUIDE Individuals data connected to the efficiency measures that CMS uses to determine the GUIDE Individual's performance-based modification to the DCMP.GUIDE Individuals in the established program track ought to be prepared to start furnishing services under the GUIDE Design on July 1, 2024, and bill for those services throughout the Model Performance Period.

Yes, GUIDE recipient and service provider overlap with the Shared Savings Program is permitted. The GUIDE Model is created to be compatible with other CMS models and programs that intend to enhance care and lower spending. CMS thinks targeted assistance for individuals 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 Design and the Shared Cost Savings Program during Performance Year 2024 and then renews and begins a brand-new arrangement 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 Benchmark Year 3. GUIDE Respite Service claims will not be counted toward ACO expenditures, shared cost savings, nor benchmarking beginning in 2024 for the duration of the GUIDE Design.

GUIDE Individuals may take part in numerous CMS Development Center designs or Medicare value-based care efforts to accelerate innovation in care delivery, reduce the expense of care, and improve population health. Participants and beneficiaries are eligible to participate in the GUIDE Model 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 claims in the REACH ACOs' total expense of care expenditures or computation of shared savings/shared losses.

Overlapping participants should follow GUIDE billing guidance as set forth below. GUIDE Reprieve 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 likewise taking part in ACO REACH must cease billing the Medicare Doctor Charge Schedule Providers consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Approach Paper (PDF)). Participants getting involved in both models must follow the GUIDE billing requirements in the GUIDE Participation Contract and GUIDE Payment Method Paper.

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The GUIDE Participant should not bill Medicare independently for the services supplied in the thorough evaluation. The comprehensive evaluation (and any re-assessments) is covered by the DCMP. If CMS determines the beneficiary is not qualified for the GUIDE Design, the GUIDE Individual can bill for an appropriate Medicare-covered expert service that corresponds to the services rendered.