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GUIDE Individuals have the choice, and are not needed, to make readily available reprieve through an adult day center or a 24-hour facility. Extra GUIDE Break Providers requirements and details surrounding the payment for such services are specified in the Participation Arrangement. GUIDE Individuals in the new program track that are categorized as safeguard suppliers will be eligible to receive a one-time infrastructure payment of $75,000 (geographically changed by the Geographic Adjustment Factor [GAF] to cover some of the upfront costs of establishing a new dementia care program.

The facilities payment is intended for suppliers who desire to develop brand-new dementia care programs and require resources to begin. GUIDE Participants qualified as a security net company based on the proportion of their patient 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 security internet company, a new program candidate should have had a Medicare FFS recipient population made up of at least 36% recipients receiving the Part D low-income subsidy or 33.7% beneficiaries who are dually eligible for Medicare and Medicaid. Accepting the facilities payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE break services will undergo recipient cost-sharing.

When a lined up beneficiary is re-assessed and designated to a brand-new tier, the GUIDE Individual will be eligible to bill the G-code for the established patient payment rate related to that tier the following month. GUIDE Individuals that withdraw or are ended before the start of the second performance year will be required to repay the entire value of their facilities payment to CMS.

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After the 2nd performance year, GUIDE Individuals that withdraw or are ended from the GUIDE Model are not required to pay back 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 change fee-for-service payment for some existing Medicare Physician Fee Schedule (PFS) services, consisting of persistent care management and primary care management, transitional care management, advance care preparation, and technology-based check-ins.

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The GUIDE Model 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 consisted of under the DCMP. Extra info, consisting of a complete list of duplicative codes, is offered in the Ask for Applications (Table 8, pg. 35). CMS might include or get rid of codes gradually to show modifications in PFS billing codes.

The care group may include the recipient's main care company, and if not, the care group is needed to determine and share information with the beneficiary's medical care provider and experts and lay out the care coordination services needed to handle the beneficiary's dementia and co-occurring conditions. CMS will supply GUIDE Participants data related to the performance determines that CMS utilizes to figure out the GUIDE Individual's performance-based change to the DCMP.GUIDE Individuals in the recognized program track need to be prepared to start furnishing services under the GUIDE Model on July 1, 2024, and costs for those services during the Model Efficiency Period.

Yes, GUIDE recipient and provider overlap with the Shared Cost savings Program is permitted. The GUIDE Model is designed to be compatible with other CMS models and programs that aim to improve care and lower spending. CMS believes targeted support for individuals with dementia and their caretakers will help enhance population-based care results 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 Savings Program expenses. When 2024 ends up being a benchmark year, DCMPs will be consisted of in Shared Cost savings Program criteria calculations. As an example, if an ACO is taking part in both the GUIDE Design and the Shared Cost Savings Program during Efficiency Year 2024 and after that restores and starts a new agreement duration as of January 1, 2025, that ACO would have their Shared Cost savings Program standard based on 2022, 2023 and 2024, and would have DCMPs counted in Standard Year 3. GUIDE Respite Service claims will not be counted towards ACO expenditures, shared savings, nor benchmarking beginning in 2024 for the duration of the GUIDE Design.

GUIDE Participants may take part in numerous CMS Innovation Center models or Medicare value-based care initiatives to speed up development in care shipment, reduce the expense of care, and enhance population health. Participants and beneficiaries are qualified to participate in the GUIDE Design 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 expenses or computation of shared savings/shared losses.

Overlapping individuals ought to follow GUIDE billing guidance as set forth below. GUIDE Break Service claims will not count toward ACO expenditures, shared cost savings, or benchmarking in 2025 and for the duration of the GUIDE Model.

As of January 1, 2025, GUIDE Participants likewise taking part in ACO REACH should stop billing the Medicare Doctor Fee Schedule Solutions consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Method Paper (PDF)). Individuals getting involved in both designs need to follow the GUIDE billing requirements in the GUIDE Participation Contract and GUIDE Payment Methodology Paper.

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The GUIDE Individual must not bill Medicare separately for the services offered in the extensive assessment. The thorough evaluation (and any re-assessments) is covered by the DCMP. If CMS figures out the beneficiary is not qualified for the GUIDE Model, the GUIDE Individual can bill for an appropriate Medicare-covered expert service that represents the services rendered.