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GUIDE Individuals have the choice, and are not required, to make readily available respite through an adult day center or a 24-hour center. Additional GUIDE Reprieve Solutions requirements and details surrounding the payment for such services are specified in the Involvement Contract. GUIDE Participants in the brand-new program track that are classified as safeguard providers will be eligible to receive a one-time facilities payment of $75,000 (geographically changed by the Geographic Modification Aspect [GAF] to cover a few of the in advance costs of developing a new dementia care program.

The facilities payment is planned for providers who wish to establish brand-new dementia care programs and need resources to get going. GUIDE Individuals certified as a safeguard supplier based on the proportion of their patient population that is dually qualified for Medicare and Medicaid or get the Part D low-income aid.

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To qualify as a GUIDE safety net provider, a new program applicant must have had a Medicare FFS beneficiary 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 respite services will undergo beneficiary 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 recognized patient payment rate related to that tier the following month. GUIDE Individuals that withdraw or are terminated before the start of the 2nd performance year will be required to pay back the whole worth of their infrastructure 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 needed to repay the infrastructure 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 Fee Arrange (PFS) services, including chronic care management and primary care management, transitional care management, advance care planning, and technology-based check-ins.

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The GUIDE Model is not a total-cost-of-care design, so GUIDE Participants will continue to costs under standard Medicare fee-for-service for all services that are not included under the DCMP. CMS might add or eliminate codes over time to show changes in PFS billing codes.

The care team may consist of the recipient's medical care service provider, and if not, the care team is needed to identify and share info with the recipient's main care company and experts and lay out the care coordination services required to handle the beneficiary's dementia and co-occurring conditions. CMS will provide GUIDE Participants data associated with the efficiency measures that CMS utilizes to identify the GUIDE Individual's performance-based adjustment to the DCMP.GUIDE Individuals in the established program track need to be prepared to start furnishing services under the GUIDE Design on July 1, 2024, and costs for those services during the Design Efficiency Duration.

Yes, GUIDE recipient and provider overlap with the Shared Cost savings Program is permitted. The GUIDE Design is created to be compatible with other CMS models and programs that intend to improve care and minimize spending. CMS thinks targeted assistance for individuals with dementia and their caregivers will help improve population-based care outcomes overall.

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The Dementia Care Management Payment (DCMP), the per recipient each month GUIDE payment, will be consisted of in 2024 Shared Cost savings Program expenses. When 2024 ends up being a benchmark year, DCMPs will be included in Shared Savings Program criteria computations. As an example, if an ACO is participating in both the GUIDE Design and the Shared Savings Program during Efficiency Year 2024 and after that restores and begins a brand-new agreement duration 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. Nevertheless, GUIDE Reprieve Service claims will not be counted toward ACO expenditures, shared cost savings, nor benchmarking beginning in 2024 throughout of the GUIDE Design.

GUIDE Participants may take part in multiple CMS Innovation Center models or Medicare value-based care efforts to accelerate innovation in care delivery, minimize the expense of care, and improve population health. Participants 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 Break Service declares in the REACH ACOs' total expense of care expenditures or calculation of shared savings/shared losses.

Overlapping participants need to follow GUIDE billing guidance as set forth below. GUIDE Reprieve Service claims will not count towards ACO expenses, shared savings, or benchmarking in 2025 and for the period of the GUIDE Model.

Since January 1, 2025, GUIDE Participants also taking part in ACO REACH need to terminate billing the Medicare Physician Fee Arrange Services consisted of under the DCMP (See Display 5 in the GUIDE Payment Methodology Paper (PDF)). Participants getting involved in both models need to follow the GUIDE billing requirements in the GUIDE Participation Contract and GUIDE Payment Method Paper.

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The GUIDE Participant need to not bill Medicare separately for the services supplied in the detailed assessment. The extensive evaluation (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 expert service that represents the services rendered.