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However, GUIDE Individuals have the alternative, and are not required, to make available respite through an adult day center or a 24-hour center. Extra GUIDE Respite Providers requirements and information surrounding the payment for such services are specified in the Involvement Contract. GUIDE Individuals in the new program track that are classified as safeguard service providers will be qualified to get a one-time facilities payment of $75,000 (geographically changed by the Geographic Adjustment Aspect [GAF] to cover a few of the in advance expenses of developing a brand-new dementia care program.

The infrastructure payment is planned for suppliers who desire to develop brand-new dementia care programs and require resources to begin. GUIDE Participants certified as a security net company based upon the proportion of their patient population that is dually eligible for Medicare and Medicaid or get the Part D low-income aid.

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To certify as a GUIDE safeguard provider, a new program applicant should have had a Medicare FFS beneficiary population comprised of at least 36% beneficiaries receiving the Part D low-income aid or 33.7% recipients 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 recipient is re-assessed and appointed to a new tier, the GUIDE Individual will be eligible to bill the G-code for the established patient payment rate associated with that tier the following month. GUIDE Participants that withdraw or are ended before the start of the second efficiency year will be needed to pay back the whole value of their infrastructure payment to CMS.

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After the 2nd performance year, GUIDE Individuals that withdraw or are terminated from the GUIDE Design are not needed to pay back the facilities payment. The main 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 change fee-for-service payment for some existing Medicare Doctor Cost Arrange (PFS) services, consisting of chronic 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 Participants will continue to expense under traditional Medicare fee-for-service for all services that are not included under the DCMP. Additional info, consisting of a complete list of duplicative codes, is offered in the Demand for Applications (Table 8, pg. 35). CMS might add or eliminate codes over time to reflect modifications in PFS billing codes.

The care group may consist of the recipient's main care supplier, and if not, the care team is required to determine and share details with the beneficiary's main care provider and specialists and describe the care coordination services needed to handle the beneficiary's dementia and co-occurring conditions. CMS will offer GUIDE Participants data related to the performance measures that CMS utilizes to determine the GUIDE Individual's performance-based modification to the DCMP.GUIDE Individuals in the recognized program track ought to be prepared to begin providing services under the GUIDE Design on July 1, 2024, and expense for those services throughout the Model Performance Period.

Yes, GUIDE beneficiary and supplier overlap with the Shared Cost savings Program is allowed. The GUIDE Model is developed to be compatible with other CMS models and programs that aim to enhance care and decrease costs. CMS believes targeted assistance for individuals with dementia and their caregivers will assist enhance population-based care results in general.

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As an example, if an ACO is taking part in both the GUIDE Design and the Shared Cost Savings Program throughout Efficiency Year 2024 and then renews and begins a new arrangement duration as of January 1, 2025, that ACO would have their Shared Cost savings Program benchmark based on 2022, 2023 and 2024, and would have DCMPs counted in Criteria Year 3. GUIDE Reprieve Service claims will not be counted toward ACO expenditures, shared cost savings, nor benchmarking start in 2024 for the period of the GUIDE Model.

GUIDE Individuals may take part in numerous CMS Innovation Center designs or Medicare value-based care efforts to accelerate development in care shipment, lower the expense of care, and improve population health. Participants and beneficiaries are eligible to participate in the GUIDE Model 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 declares in the REACH ACOs' overall cost of care expenses or calculation of shared savings/shared losses.

Overlapping participants should follow GUIDE billing guidance as stated listed below. ACO REACH claim reductions will not apply to DCMP. ACO REACH will consist of DCMP expenses for functions of alignment estimations. However, GUIDE Reprieve Service claims will not count toward ACO expenses, shared cost savings, or benchmarking in 2025 and throughout of the GUIDE Design.

As of January 1, 2025, GUIDE Individuals likewise taking part in ACO REACH should discontinue billing the Medicare Doctor Charge Set up Services consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Approach Paper (PDF)). Participants taking part in both designs must follow the GUIDE billing requirements in the GUIDE Participation Contract and GUIDE Payment Methodology Paper.

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The GUIDE Participant should not bill Medicare independently for the services offered in the comprehensive assessment. The thorough evaluation (and any re-assessments) is covered by the DCMP. If CMS determines the beneficiary is not eligible for the GUIDE Model, the GUIDE Individual can bill for a suitable Medicare-covered expert service that corresponds to the services rendered.