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However, GUIDE Individuals have the option, and are not needed, to offer respite 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 Involvement Contract. GUIDE Participants in the new program track that are categorized as security net suppliers will be qualified to get a one-time infrastructure payment of $75,000 (geographically adjusted by the Geographic Adjustment Factor [GAF] to cover a few of the upfront costs of developing a new dementia care program.

The infrastructure payment is planned for providers who wish to develop new dementia care programs and need resources to get going. GUIDE Individuals qualified as a security net supplier based upon the percentage of their client population that is dually eligible for Medicare and Medicaid or get the Part D low-income subsidy.

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To certify as a GUIDE safeguard service provider, a brand-new program candidate need to have had a Medicare FFS recipient population consisted 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 infrastructure payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE reprieve services will go through recipient cost-sharing.

When an aligned beneficiary is re-assessed and designated to a new tier, the GUIDE Individual will be qualified to bill the G-code for the recognized patient payment rate related to that tier the following month. GUIDE Participants that withdraw or are ended before the start of the 2nd performance year will be required to pay back the whole value of their infrastructure payment to CMS.

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After the second performance year, GUIDE Individuals that withdraw or are ended from the GUIDE Model are not required to pay back 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 replace fee-for-service payment for some existing Medicare Physician Charge Set Up (PFS) services, including persistent care management and primary 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 traditional Medicare fee-for-service for all services that are not included under the DCMP. CMS may include or eliminate codes over time to reflect modifications in PFS billing codes.

The care team might consist of the beneficiary's medical care supplier, and if not, the care team is needed to identify and share info with the beneficiary's medical care service provider and experts and describe the care coordination services needed to manage the beneficiary's dementia and co-occurring conditions. CMS will provide GUIDE Participants information related to the performance measures that CMS uses to identify the GUIDE Individual's performance-based change to the DCMP.GUIDE Participants in the established program track should be prepared to start providing services under the GUIDE Design on July 1, 2024, and bill for those services throughout the Design Efficiency Period.

Yes, GUIDE recipient and service provider overlap with the Shared Savings Program is enabled. The GUIDE Design is developed to be compatible with other CMS models and programs that intend to enhance care and lower spending. CMS thinks targeted support for people with dementia and their caretakers will assist enhance population-based care results in general.

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The Dementia Care Management Payment (DCMP), the per recipient monthly GUIDE payment, will be consisted of in 2024 Shared Cost savings Program expenditures. When 2024 becomes a benchmark year, DCMPs will be included in Shared Cost savings Program benchmark calculations. As an example, if an ACO is getting involved in both the GUIDE Design and the Shared Savings Program throughout Performance Year 2024 and then renews and starts a brand-new contract period as of January 1, 2025, that ACO would have their Shared Savings Program criteria 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 beginning in 2024 for the period of the GUIDE Model.

GUIDE Individuals may take part in several CMS Development Center models or Medicare value-based care initiatives to speed up development in care delivery, lower the cost of care, and improve population health. Individuals and beneficiaries are eligible to take part in the GUIDE Model and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not include the Dementia Care Management Payment (DCMP) or Reprieve Service claims in the REACH ACOs' overall expense of care expenses or computation of shared savings/shared losses.

Overlapping individuals must follow GUIDE billing assistance as set forth below. GUIDE Reprieve Service claims will not count towards ACO expenditures, shared savings, or benchmarking in 2025 and for the period of the GUIDE Model.

As of January 1, 2025, GUIDE Individuals likewise taking part in ACO REACH ought to cease billing the Medicare Doctor Charge Arrange Solutions included under the DCMP (See Display 5 in the GUIDE Payment Approach Paper (PDF)). Individuals participating 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 must not bill Medicare separately for the services provided in the thorough assessment. The thorough evaluation (and any re-assessments) is covered by the DCMP. If CMS determines the beneficiary is not eligible for the GUIDE Model, the GUIDE Individual can bill for a suitable Medicare-covered expert service that represents the services rendered.