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Nevertheless, GUIDE Participants have the choice, and are not needed, to offer break through an adult day center or a 24-hour facility. Additional GUIDE Respite Services requirements and details surrounding the payment for such services are specified in the Participation Contract. GUIDE Participants in the brand-new program track that are categorized as security net service providers will be eligible to get a one-time infrastructure payment of $75,000 (geographically adjusted by the Geographic Modification Aspect [GAF] to cover some of the in advance costs of establishing a brand-new dementia care program.

The infrastructure payment is planned for service providers who wish to develop new dementia care programs and require resources to get begun. GUIDE Individuals qualified as a safeguard supplier based on the percentage of their patient population that is dually qualified for Medicare and Medicaid or receive the Part D low-income aid.

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To certify as a GUIDE safety internet service provider, a brand-new program applicant must have had a Medicare FFS beneficiary population consisted of a minimum of 36% recipients getting the Part D low-income aid or 33.7% beneficiaries 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 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 established client payment rate associated with that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the 2nd efficiency year will be needed to pay back the entire worth of their facilities payment to CMS.

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After the second performance year, GUIDE Participants that withdraw or are terminated from the GUIDE Model are not needed to pay back the infrastructure payment. The primary model 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 Cost Arrange (PFS) services, consisting of persistent care management and principal 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 Individuals will continue to expense 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 reflect changes in PFS billing codes.

The care team may include the beneficiary's main care service provider, and if not, the care group is needed to recognize and share details with the recipient's medical care supplier and specialists and outline the care coordination services needed to manage the beneficiary's dementia and co-occurring conditions. CMS will supply GUIDE Individuals information associated with the efficiency measures that CMS utilizes to determine the GUIDE Individual's performance-based adjustment to the DCMP.GUIDE Individuals in the recognized program track need to be prepared to begin providing services under the GUIDE Model on July 1, 2024, and costs for those services throughout the Model Efficiency Duration.

Yes, GUIDE recipient and provider overlap with the Shared Savings Program is allowed. The GUIDE Design is designed to be suitable with other CMS designs and programs that intend to improve care and reduce spending. CMS thinks targeted assistance for individuals with dementia and their caregivers will assist enhance population-based care results 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 renews and starts a new agreement duration as of January 1, 2025, that ACO would have their Shared Savings Program criteria based on 2022, 2023 and 2024, and would have DCMPs counted in Benchmark Year 3. GUIDE Respite Service claims will not be counted toward ACO expenditures, shared savings, nor benchmarking beginning in 2024 for the period of the GUIDE Model.

GUIDE Participants may get involved in multiple CMS Innovation Center models or Medicare value-based care initiatives to speed up innovation in care shipment, reduce the cost of care, and enhance population health. Participants and beneficiaries are qualified to get involved 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 Break Service claims in the REACH ACOs' total expense of care expenses or calculation of shared savings/shared losses.

Overlapping participants should follow GUIDE billing guidance as stated below. ACO REACH claim decreases will not apply to DCMP. ACO REACH will consist of DCMP expenditures for purposes of positioning estimations. Nevertheless, GUIDE Break Service claims will not count toward ACO expenditures, shared cost savings, or benchmarking in 2025 and throughout of the GUIDE Design.

As of January 1, 2025, GUIDE Individuals also taking part in ACO REACH ought to discontinue billing the Medicare Doctor Fee Arrange Solutions consisted of under the DCMP (See Exhibition 5 in the GUIDE Payment Approach Paper (PDF)). Individuals participating in both models need to follow the GUIDE billing requirements in the GUIDE Involvement Arrangement and GUIDE Payment Methodology Paper.

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The GUIDE Participant must not bill Medicare independently for the services offered in the detailed evaluation. The thorough evaluation (and any re-assessments) is covered by the DCMP. If CMS identifies the beneficiary is not eligible for the GUIDE Model, the GUIDE Participant can bill for a suitable Medicare-covered professional service that represents the services rendered.