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A beneficiary is qualified to receive services under the GUIDE Design if they meet the following criteria: Has dementia, as confirmed by attestation from a clinician on the GUIDE Individual's GUIDE Professional Roster; Is registered in Medicare Parts A and B (not enrolled in Medicare Benefit, including Special Needs Strategies, or PACE programs) and has Medicare as their main payer; Has not chosen the Medicare hospice advantage, and; Is not a long-lasting assisted living home homeowner.

The table listed below shows a description of the five tiers. GUIDE Participants will report information on illness stage and caregiver status to CMS when a recipient is very first lined up to a participant in the model. To guarantee constant beneficiary task to tiers across design individuals, GUIDE Participants need to utilize a tool from a set of authorized screening and measurement tools to determine dementia phase and caregiver problem.

GUIDE Individuals must notify beneficiaries about the design and the services that beneficiaries can get through the model, and they must record that a recipient or their legal representative, if appropriate, approvals to receiving services from them. GUIDE Participants need to then send the consenting recipient's details to CMS and, within 15 days, CMS will confirm whether the beneficiary satisfies the design eligibility requirements before lining up the recipient to the GUIDE Individual.

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For a person with Medicare to receive services under the design, they should satisfy certain eligibility requirements. They will also require to find a health care company that is taking part in the GUIDE Model in their neighborhood. CMS will publish a list of GUIDE Individuals on the GUIDE site in Summer season 2024.

For immediate assistance, please find the following resources: and . You might also call 1-800-MEDICARE for specific details on concerns regarding Medicare advantages. For the purposes of the GUIDE Design, a caregiver is defined as a relative, or unsettled nonrelative, who helps the recipient with activities of day-to-day living and/or critical activities of day-to-day living.

People with Medicare should have dementia to be qualified for voluntary alignment to a GUIDE Individual and might be at any phase of dementiamild, moderate, or serious. When a person with Medicare is very first assessed for the GUIDE Design, CMS will count on clinician attestation rather than the existence of ICD-10 dementia diagnosis codes on previous Medicare claims.

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Additionally, they might confirm that they have received a written report of a documented dementia diagnosis from another Medicare-enrolled professional. When a recipient is voluntarily lined up to a GUIDE Individual, the GUIDE Individual should connect an eligible ICD-10 dementia medical diagnosis code to each Dementia Care Management Payment (DCMP) regular monthly claim in order for it to be paid by CMS.The authorized screening tools consist of 2 tools to report dementia phase the Clinical Dementia Ranking (CDR) or the Practical Evaluation Screening Tool (QUICK) and one tool to report caretaker strain, the Zarit Burden Interview (ZBI).

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GUIDE Individuals have the alternative to seek CMS approval to utilize an alternative screening tool by submitting the proposed tool, along with published evidence that it is valid and reputable and a crosswalk for how it represents the design's tiering thresholds. CMS has full discretion on whether it will accept the proposed option tool.

The GUIDE Design requires Care Navigators to be trained to work with caregivers in determining and managing typical behavioral changes due to dementia. GUIDE Participants will likewise assess the recipient's behavioral health as part of the detailed assessment and supply beneficiaries and their caregivers with 24/7 access to a care staff member or helpline.

A lined up recipient would be deemed disqualified if they no longer meet one or more of the recipient eligibility requirements. This might take place, for instance, if the beneficiary ends up being a long-lasting assisted living home homeowner, enrolls in Medicare Benefit, or stops receiving the GUIDE care delivery services from the GUIDE Participant (e.g., because they move out of the program service area, no longer wish to be lined up to the GUIDE Participant, or can not be contacted/are lost to follow-up). The GUIDE Design is not an overall cost of care model and does not have requirements around specific drug treatments.

GUIDE Participants will be enabled to modify their service location throughout the period of the Model. Candidates may select a service location of any size as long as they will be able to supply all of the GUIDE Care Shipment Provider to beneficiaries in the identified service locations. Recipients who reside in assisted living settings might receive alignment to a GUIDE Participant offered they meet all other eligibility requirements. The GUIDE Individual will identify the recipient's main caretaker and assess the caregiver's understanding, requires, well-being, tension level, and other difficulties, consisting of reporting caregiver pressure to CMS utilizing the Zarit Concern Interview.

The GUIDE Design is not a shared cost savings or overall cost of care model, it is a condition-specific longitudinal care design. In basic, GUIDE Design participants will be paid a month-to-month dementia care management payment (DCMP) for each recipient. The GUIDE Design is created to be compatible with other CMS responsible care designs and programs (e.g., ACOs and advanced medical care designs) that provide health care entities with chances to improve care and lower spending.

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DCMP rates will be geographically changed in addition to a Performance Based Modification (PBA) to incentivize top quality care. The GUIDE Model will also pay for a specified quantity of break services for a subset of design recipients. Model individuals will use a set of brand-new G-codes developed for the GUIDE Design to send claims for the monthly DCMP and the respite codes.

Break services will be paid up to an annual cap of $2,500 per beneficiary and will differ in system costs based on the kind of respite service used. Yes, the monthly rates by tier are available listed below.(New Client Payment Rate)$150$275$360$230$390(Established Client Payment Rate)$65$120$220$120$215GUIDE Individuals are accountable for paying Partner Organizations for GUIDE care shipment services that the Partner Organization supplies to the GUIDE Individual's lined up recipients.

GUIDE Participants and Partner Organizations will determine a payment plan and GUIDE Individuals should have agreements in location with their Partner Organizations to show this payment plan. GUIDE Participants will likewise be expected to maintain a list of Partner Organizations ("Partner Company Lineup") and upgrade it as changes are made throughout the course of the GUIDE Design.