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GUIDE Individuals have the alternative, and are not required, to make readily available reprieve through an adult day center or a 24-hour center. Extra GUIDE Reprieve Solutions requirements and information surrounding the payment for such services are specified in the Participation Contract.

The infrastructure payment is intended for service providers who desire to establish new dementia care programs and need resources to get going. GUIDE Participants certified as a safeguard company based upon the proportion of their patient population that is dually qualified for Medicare and Medicaid or receive the Part D low-income subsidy.

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To qualify as a GUIDE safeguard supplier, a brand-new program applicant should have had a Medicare FFS recipient population made up of at least 36% recipients receiving the Part D low-income aid or 33.7% beneficiaries 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 beneficiary cost-sharing.

When an aligned beneficiary is re-assessed and appointed to a brand-new tier, the GUIDE Participant will be qualified to bill the G-code for the established patient payment rate connected with that tier the following month. GUIDE Individuals that withdraw or are ended before the start of the second efficiency year will be needed to pay back the entire value of their facilities payment to CMS.

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After the 2nd performance year, GUIDE Participants that withdraw or are ended from the GUIDE Design 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 change fee-for-service payment for some existing Medicare Doctor Charge Set Up (PFS) services, including persistent care management and primary 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 design, so GUIDE Participants will continue to bill under traditional Medicare fee-for-service for all services that are not included under the DCMP. Extra details, consisting of a total list of duplicative codes, is readily available in the Demand for Applications (Table 8, pg. 35). CMS may add or get rid of codes gradually to show changes in PFS billing codes.

The care team may include the recipient's main care service provider, and if not, the care group is needed to determine and share info with the recipient's primary care company and professionals and describe the care coordination services needed to manage the beneficiary's dementia and co-occurring conditions. CMS will offer GUIDE Participants information related to the performance determines that CMS uses to determine the GUIDE Individual's performance-based modification to the DCMP.GUIDE Participants 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 throughout the Design Performance Duration.

Yes, GUIDE recipient and supplier overlap with the Shared Cost savings Program is permitted. The GUIDE Design is developed to be suitable with other CMS designs and programs that intend to improve care and lower spending. CMS thinks targeted assistance for people with dementia and their caregivers will help improve population-based care outcomes overall.

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As an example, if an ACO is getting involved in both the GUIDE Model and the Shared Cost Savings Program during Efficiency Year 2024 and then restores and begins a brand-new agreement period as of January 1, 2025, that ACO would have their Shared 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 period of the GUIDE Model.

GUIDE Individuals might take part in numerous CMS Development Center designs or Medicare value-based care efforts to accelerate innovation in care shipment, lower the expense of care, and enhance population health. Individuals 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' overall expense of care expenditures or computation of shared savings/shared losses.

Overlapping individuals need to follow GUIDE billing assistance as set forth listed below. GUIDE Respite Service claims will not count towards ACO expenditures, shared cost savings, or benchmarking in 2025 and for the duration of the GUIDE Design.

As of January 1, 2025, GUIDE Participants likewise taking part in ACO REACH should discontinue billing the Medicare Physician Charge Schedule Services consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Method Paper (PDF)). Participants taking part in both models need to follow the GUIDE billing requirements in the GUIDE Participation Arrangement and GUIDE Payment Method Paper.

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The GUIDE Individual need to not bill Medicare individually for the services provided in the extensive assessment. The extensive assessment (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 suitable Medicare-covered expert service that represents the services rendered.