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GUIDE Individuals have the alternative, 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 Involvement Agreement.

The infrastructure payment is planned for companies who desire to develop new dementia care programs and need resources to start. GUIDE Participants certified as a safeguard supplier based on 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 qualify as a GUIDE safety web provider, a new program candidate need to have had a Medicare FFS recipient population consisted of a minimum of 36% recipients receiving the Part D low-income subsidy 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 be subject to beneficiary cost-sharing.

When a lined up recipient is re-assessed and assigned to a brand-new tier, the GUIDE Individual will be eligible to bill the G-code for the recognized client payment rate associated with that tier the following month. GUIDE Individuals that withdraw or are ended before the start of the 2nd efficiency year will be needed to repay the entire value of their infrastructure payment to CMS.

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After the second efficiency year, GUIDE Participants that withdraw or are terminated from the GUIDE Model are not needed to pay back the infrastructure payment. The primary 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 Arrange (PFS) services, consisting of 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 expense under conventional Medicare fee-for-service for all services that are not included under the DCMP. CMS might add or remove codes over time to show changes in PFS billing codes.

The care team may consist of the recipient's main care service provider, and if not, the care team is required to identify and share information with the beneficiary's main care provider and specialists and lay out the care coordination services required to handle the beneficiary's dementia and co-occurring conditions. CMS will offer GUIDE Participants information associated with the performance measures that CMS uses to identify the GUIDE Participant's performance-based change to the DCMP.GUIDE Individuals in the established program track must be prepared to start providing services under the GUIDE Design on July 1, 2024, and costs for those services during the Design Performance Period.

Yes, GUIDE recipient and company overlap with the Shared Cost savings Program is allowed. The GUIDE Design is designed to be suitable with other CMS models and programs that aim to enhance care and minimize spending. CMS believes targeted assistance for individuals with dementia and their caregivers will help enhance population-based care results overall.

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The Dementia Care Management Payment (DCMP), the per recipient monthly GUIDE payment, will be included in 2024 Shared Cost savings Program expenses. When 2024 becomes a benchmark year, DCMPs will be included in Shared Cost savings Program standard computations. As an example, if an ACO is getting involved in both the GUIDE Model and the Shared Cost Savings Program during Performance Year 2024 and after that restores and starts a 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 Standard Year 3. Nevertheless, GUIDE Reprieve Service claims will not be counted toward ACO expenditures, shared cost savings, nor benchmarking beginning in 2024 for the period of the GUIDE Design.

GUIDE Individuals might take part in several CMS Innovation Center models or Medicare value-based care initiatives to speed up development in care shipment, lower the cost of care, and enhance population health. Participants and recipients 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 Break Service declares in the REACH ACOs' overall expense of care expenses or calculation of shared savings/shared losses.

Overlapping individuals should follow GUIDE billing assistance as set forth below. ACO REACH claim decreases will not apply to DCMP. ACO REACH will consist of DCMP expenses for functions of alignment computations. GUIDE Break Service claims will not count toward ACO expenditures, shared cost savings, or benchmarking in 2025 and for the period of the GUIDE Model.

Since January 1, 2025, GUIDE Participants likewise taking part in ACO REACH need to discontinue billing the Medicare Physician Fee Arrange Solutions consisted of under the DCMP (See Display 5 in the GUIDE Payment Approach Paper (PDF)). Participants taking part in both models should follow the GUIDE billing requirements in the GUIDE Involvement Arrangement and GUIDE Payment Approach Paper.

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The GUIDE Participant must not bill Medicare independently for the services provided in the detailed assessment. The detailed assessment (and any re-assessments) is covered by the DCMP. If CMS identifies the beneficiary is not eligible for the GUIDE Design, the GUIDE Individual can bill for a proper Medicare-covered professional service that corresponds to the services rendered.