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GUIDE Individuals have the option, and are not required, to make offered break through an adult day center or a 24-hour center. Extra GUIDE Respite Services requirements and details surrounding the payment for such services are defined in the Involvement Agreement.

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

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To certify as a GUIDE safeguard provider, a new program applicant must have had a Medicare FFS recipient population consisted of a minimum of 36% recipients receiving the Part D low-income subsidy 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 reprieve services will undergo beneficiary cost-sharing.

When an aligned 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 related to that tier the following month. GUIDE Individuals that withdraw or are ended before the start of the second performance year will be needed to repay the whole worth of their facilities payment to CMS.

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After the 2nd efficiency year, GUIDE Participants that withdraw or are terminated from the GUIDE Model are not needed to repay the infrastructure payment. The primary design payment under the GUIDE Model 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 Physician Charge 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 conventional Medicare fee-for-service for all services that are not included under the DCMP. Extra information, including a total list of duplicative codes, is offered in the Ask for Applications (Table 8, pg. 35). CMS might include or eliminate codes over time to reflect modifications in PFS billing codes.

The care group might consist of the recipient's primary care supplier, and if not, the care group is required to identify and share details with the beneficiary's primary care service provider and professionals and describe the care coordination services required to manage the beneficiary's dementia and co-occurring conditions. CMS will provide GUIDE Individuals information associated with the efficiency determines that CMS uses to figure out the GUIDE Participant's performance-based adjustment to the DCMP.GUIDE Individuals in the recognized program track must be prepared to begin providing services under the GUIDE Model on July 1, 2024, and costs for those services throughout the Design Efficiency Period.

Yes, GUIDE recipient and service provider overlap with the Shared Cost savings Program is enabled. The GUIDE Design is designed to be suitable with other CMS designs and programs that aim to improve care and lower costs. CMS believes targeted assistance for people with dementia and their caregivers will assist enhance population-based care results in general.

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The Dementia Care Management Payment (DCMP), the per recipient per month GUIDE payment, will be included in 2024 Shared Savings Program expenditures. When 2024 ends up being a benchmark year, DCMPs will be included in Shared Cost savings Program standard calculations. As an example, if an ACO is taking part in both the GUIDE Design and the Shared Cost Savings Program during Performance Year 2024 and after that restores and begins a new agreement period as of January 1, 2025, that ACO would have their Shared Savings Program criteria based upon 2022, 2023 and 2024, and would have DCMPs counted in Standard Year 3. Nevertheless, GUIDE Break Service claims will not be counted towards ACO expenses, shared savings, nor benchmarking start in 2024 throughout of the GUIDE Design.

GUIDE Participants might take part in numerous CMS Development Center designs or Medicare value-based care initiatives to accelerate innovation in care delivery, decrease the expense of care, and enhance population health. Participants and recipients are qualified to take part in the GUIDE Model and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not consist of the Dementia Care Management Payment (DCMP) or Reprieve Service declares in the REACH ACOs' overall expense of care expenses or computation of shared savings/shared losses.

Overlapping participants ought to follow GUIDE billing guidance as set forth listed below. GUIDE Break Service claims will not count toward ACO expenditures, shared cost savings, or benchmarking in 2025 and for the period of the GUIDE Model.

Since January 1, 2025, GUIDE Individuals also getting involved in ACO REACH must discontinue billing the Medicare Physician Fee Schedule Providers consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Approach Paper (PDF)). Individuals taking part in both models must follow the GUIDE billing requirements in the GUIDE Involvement Arrangement and GUIDE Payment Method Paper.

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The GUIDE Participant need to not bill Medicare individually for the services supplied in the thorough assessment. The comprehensive assessment (and any re-assessments) is covered by the DCMP. If CMS identifies the recipient is not eligible for the GUIDE Design, the GUIDE Participant can bill for an appropriate Medicare-covered professional service that corresponds to the services rendered.