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GUIDE Individuals have the choice, and are not required, to make offered break through an adult day center or a 24-hour center. Additional GUIDE Respite Services requirements and information surrounding the payment for such services are specified in the Participation Contract.

The facilities payment is intended for service providers who wish to develop new dementia care programs and need resources to get started. GUIDE Individuals qualified as a safeguard provider based upon the percentage of their client population that is dually eligible for Medicare and Medicaid or receive the Part D low-income subsidy.

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To certify as a GUIDE safeguard company, a new program applicant should have had a Medicare FFS recipient population consisted of a minimum of 36% recipients getting the Part D low-income aid or 33.7% recipients who are dually qualified 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 beneficiary is re-assessed and assigned to a new tier, the GUIDE Participant will be eligible to bill the G-code for the established patient payment rate connected with that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the 2nd performance year will be needed to pay back the entire worth of their facilities payment to CMS.

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After the second efficiency year, GUIDE Individuals that withdraw or are terminated from the GUIDE Model are not required to pay back the facilities payment. The main model 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 Fee Schedule (PFS) services, consisting of persistent care management and principal 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 model, so GUIDE Participants will continue to bill under traditional Medicare fee-for-service for all services that are not included under the DCMP. Extra information, including a complete list of duplicative codes, is available in the Demand for Applications (Table 8, pg. 35). CMS may add or get rid of codes over time to reflect modifications in PFS billing codes.

The care group might consist of the recipient's medical care provider, and if not, the care group is required to determine and share details with the recipient's medical care service provider and experts and describe the care coordination services needed to manage the recipient's dementia and co-occurring conditions. CMS will offer GUIDE Participants data related to the performance determines that CMS utilizes to figure out the GUIDE Individual's performance-based modification to the DCMP.GUIDE Participants in the recognized program track must be prepared to begin furnishing services under the GUIDE Model on July 1, 2024, and expense for those services during the Model Performance Period.

Yes, GUIDE beneficiary and supplier overlap with the Shared Savings Program is enabled. The GUIDE Design is designed to be suitable with other CMS designs and programs that aim to improve care and reduce spending. CMS believes targeted assistance for people with dementia and their caregivers will help enhance population-based care outcomes in general.

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The Dementia Care Management Payment (DCMP), the per beneficiary each month GUIDE payment, will be included in 2024 Shared Cost savings Program expenses. When 2024 ends up being a benchmark year, DCMPs will be consisted of in Shared Cost savings Program benchmark computations. As an example, if an ACO is taking part in both the GUIDE Design and the Shared Savings Program throughout Efficiency Year 2024 and after that renews and starts a brand-new contract period since 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. However, GUIDE Break Service claims will not be counted toward ACO expenses, shared savings, nor benchmarking beginning in 2024 throughout of the GUIDE Model.

GUIDE Participants may get involved in multiple CMS Innovation Center models or Medicare value-based care initiatives to accelerate development in care delivery, reduce the cost of care, and improve population health. Participants and beneficiaries are qualified to take part in the GUIDE Model and the ACO REACH Model. 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' total cost of care expenditures or computation of shared savings/shared losses.

Overlapping participants should follow GUIDE billing guidance as set forth below. ACO REACH claim decreases will not use to DCMP. ACO REACH will include DCMP expenses for functions of positioning estimations. Nevertheless, GUIDE Respite Service claims will not count toward ACO expenses, shared savings, or benchmarking in 2025 and throughout of the GUIDE Design.

As of January 1, 2025, GUIDE Participants also taking part in ACO REACH ought to terminate billing the Medicare Physician Charge Schedule Solutions consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Approach Paper (PDF)). Individuals taking part in both designs should follow the GUIDE billing requirements in the GUIDE Participation Contract and GUIDE Payment Method Paper.

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The GUIDE Participant must not bill Medicare individually for the services provided in the comprehensive evaluation. The comprehensive evaluation (and any re-assessments) is covered by the DCMP. If CMS identifies the beneficiary is not eligible for the GUIDE Model, the GUIDE Individual can bill for a proper Medicare-covered professional service that represents the services rendered.